新冠肺炎对美国艾滋病毒检测、诊断和治疗的影响研究

Study of the impact of COVID-19 onHIV testing, diagnosis, andtreatment in the United States Josh Collins,FSA, MAAA, Senior Actuarial ManagerKristin Niakan,MPH, Senior Pharmacy Benefits Analytics ManagerKali Schweitzer,PharmD, Senior Managed Care PharmacistSusan Silseth,FSA, MAAA Senior Consulting Actuary Commissioned by:Gilead Sciences, Inc. Executive Summary Since the COVID-19 pandemic hit the United States in early 2020, access to healthcare services has been widely impacted. In an effort toslow the spread of COVID-19 in 2020, the U.S. Centers for Disease Control and Prevention (CDC) released guidance to delay nonessentialprocedures, postpone routine clinical visits, and utilize telemedicine when possible.1These delays impacted diagnosis and treatment acrossmany disease states. In the case of communicable diseases like human immunodeficiency virus (HIV), reduced access to testing andtreatment can have a prolonged impact on overall HIV transmission and management. In this report, we compare rates of HIV testing, diagnosis, treatment, and HIV pre-exposure-prophylaxis (PrEP) utilization before and afterthe start of the COVID-19 pandemic, using claims data. Our findings indicate that: HIV testing declined sharply across the United States at the beginning of the pandemic when COVID-19 cases were increasing andaccess to care was limited. Through the end of 2021, testing remained below 2019 levels. Throughout 2020 and 2021, HIV testingwas on average 11% below the 2019 average level. New HIV diagnoses dropped sharply in early 2020 and remain at rates below pre-COVID-19 levels as of the end of 2021. Throughout2020 and 2021, the rate of new HIV diagnoses was on average 15% below the 2019 average. Newly diagnosed individuals starting treatment for HIV for the first time also declined steadily throughout 2020 and continued to lagbehind pre-COVID-19 levels at the end of 2021. Throughout 2020 and 2021, new treatment starts were on average 17% below the2019 average, even at times when HIV diagnoses approached 2019 levels. Utilization of HIV pre-exposure prophylaxis (PrEP) remained steady through the course of the pandemic. However, prior to thepandemic, PrEP utilization was growing. In 2021, PrEP utilization increased significantly. The impact of the pandemic on HIV testing, diagnosis, and treatment metrics varies by location. The HIV testing, diagnosis, andtreatment rates in some localities have recovered more slowly than others, with levels of HIV testing, new diagnoses, and newtreatment starts continuing to remain below pre-COVID-19 levels as of October 2021. As of October 2021, all regions except for the Midwest remained below their 2019 averages for HIV testing and new diagnoses.All regions but the Northeast remained below their 2019 averages for newly diagnosed individuals starting HIV treatment. ‒Both the South and the West regions have lower levels as of October 2021 compared to 2019 averages across all threecategories: HIV testing, diagnosis, and treatment initiation. ‒State: As of October 2021, there were 15 states with HIV testing levels at least 20% lower than their 2019 averages, 15 stateswith HIV diagnosis levels at least 20% lower than 2019 averages, and 11 states with new HIV treatment initiation levels at least20% lower than 2019 averages. As of October 2021, there were 17 states that have lower current HIV testing, diagnosis, andtreatment initiation levels compared to their 2019 averages. ‒Metropolitan statistical area (MSA): Of the 37 MSAs with a minimum of 10,000 HIV tests in 2019, as of October 2021 there were13 MSAs with HIV testing levels that were at least 20% lower than their 2019 averages, 13 MSAs with HIV diagnosis levels atleast 20% lower than 2019 averages, and 10 MSAs with new HIV treatment initiation levels at least 20% lower than 2019averages. Our study findings confirm that the COVID-19 pandemic had a negative impact on HIV testing, diagnosis, and treatment initiation metricsacross the United States. Through October 2021, our results show that all three of these metrics remain lower than their respectivepre-pandemic averages at the national level. Viewing these metrics at the state and regional level reveals that there are some areas of thecountry that have returned to pre-pandemic levels, while other areas remain below historical testing rates. Our results do not show aconsistent pattern of recovery to pre-pandemic levels by region or state across the different metrics (testing, new diagnoses, new treatmentstarts). We did not study other factors that could have an impact on HIV testing, diagnosis, and treatment such as benefit coverage changes,HIV policy coverage changes, or changes in price, among other potentially confounding factors. Consistent HIV testing is key to the early diagnosis of new HIV cases and initiation of treatment. Prolonged reductions in HIV testing,diagnosis, and treatment may have a significant impact on HIV transmission, as well as the health