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Big Drops in HIV/STI Testing (But Sometimes Not Diagnoses) When COVID Arrived
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2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
Testing rates for HIV and other sexually transmitted infections (STIs) plunged when the COVID pandemic rolled into California, according to this analysis of more than 4.7 million members of the Kaiser Permanente Southern California healthcare system [1]. Diagnosis rates for HIV and chlamydia stayed low in the COVID era, while gonorrhea diagnoses bounced back almost to pre-COVID levels and syphilis diagnoses rebounded to higher levels than seen before COVID struck.
Arrival of COVID-19 greatly altered health care in ways too numerous to tally. Noting that STI rates had been rising before COVID appeared, researchers from Kaiser Permanente Southern California listed factors that could have affected STI-related healthcare delivery after COVID appeared: provider-driven drops in face-to-face office visits; patient-driven concerns in accessing healthcare safely; shortages in reagents and other STI testing materials; and shifting resources from STI care to COVID care.
This retrospective analysis of electronic records aimed to compare rates of pre-COVID and COVID-era testing and diagnoses of HIV infection, chlamydia, gonorrhea, and syphilis in the years 2017-2020 in more than 4.7 million members of Kaiser Permanente Southern California, an integrated healthcare system.
Kaiser researchers defined the pre-COVID period as January 1, 2017 through February 29, 2020. The COVID period ran from March 1, 2020 to December 31, 2020. The study included Kaiser members at least 12 years old with at least 1 day of health insurance enrollment during the 2017-2020 study period.
Rates of testing and diagnoses of all four infections-HIV, chlamydia, gonorrhea, and syphilis-plunged early in 2020 as COVID took hold. Although testing of all these STIs rebounded modestly after nadirs around May 2020, testing and diagnosis rates did not return to pre-COVID levels for HIV and chlamydia. Testing also remained lower for gonorrhea and syphilis through the end of follow-up, but diagnoses of those two infections climbed back near pre-COVID levels or higher.
Specifically, compared with previous months, the percent change in testing and diagnosis from March through December 2020 were -34% and -30% for chlamydia and -20% and -24% for HIV. But percent changes in testing and diagnosis from March through December 2020 compared with previous months were -34% versus only -5% for gonorrhea, and -24% versus +19% for syphilis.
Rate ratios figured by log-linear Poisson regression reflected these differences in testing and diagnosis for chlamydia and HIV on the one hand, and for gonorrhea and syphilis on the other:
Rate ratios for COVID period (March-December 2020) versus pre-COVID period (January 2017-February 2020):
- HIV testing: RR 0.75, 95% confidence interval [CI] 0.74 to 0.76
- HIV diagnosis: RR 0.74, 95% CI 0.66 to 0.83
- Chlamydia testing: RR 0.69, 95% CI 0.68 to 0.69
- Chlamydia diagnosis: RR 0.71, 95% CI 0.70 to 0.73
- Gonorrhea testing: RR 0.69, 95% CI 0.68 to 0.69
- Gonorrhea diagnosis: RR 0.93, 95% CI 0.89 to 0.96
- Syphilis testing: RR 0.83, 95% CI 0.83 to 0.84
- Syphilis diagnosis: RR 1.32, 95% CI 1.27 to 1.37
The Kaiser investigators suggested that gonorrhea and syphilis may be more likely than HIV and chlamydia to cause symptoms that make people seek testing. So “patient-driven testing behaviors may help explain these results.” They added that the modest drop in gonorrhea cases and increase in syphilis diagnoses by the end of follow-up indicate that these people did not stop having sex when COVID appeared. The gonorrhea and syphilis case trends made the Kaiser team wonder whether clinically latent infections like HIV and chlamydia became underdiagnosed in the COVID period. They called for “novel strategies” to encourage sexually active people to get tested for HIV and other STIs.
Reference
1. Chang JJ, Chen Q, Hechter RC, Dionne-Odom J, Bruxvoort K. Change in HIV and STI testing and diagnoses during the COVID-19 pandemic. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 142.
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