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Elizabeth A. DiNenno, dr.1; Kevin P. Delaney, Dr. 1; Marc A. Pitasi, MPH1; Robin MacGowan, MPH1; Gillian Miles, MPH1; Andre Dailey, MSPH1; Cari Courtenay-Quirk, dr.1; Kathy Byrd, MD1; Dominique Thomas, MPA1; John T. Brooks, MD1; Demetre Daskalakis, MD; Nicoline Collins, MPH1 (Show author connection)

Discussion

In 2020, the number of HIV tests reported to CDC and BPHC-funded institutions and some commercial laboratories decreased sharply compared to 2019. All racial and ethnic groups and population groups surveyed experienced a significant reduction in HIV testing, including populations with increased potential. for HIV acquisitions, including blacks and Latinos, MSM, and transgender people, all of whom have experienced significant reductions in the availability of CDC-funded HIV testing. To see also : Researchers develop antimicrobial, plant-based food package designed to replace plastic: Starch-based fibers improve protection and reduce damage. A similar decline in clinical visits for HIV testing and other services during the COVID-19 pandemic (e.g., testing for sexually transmitted diseases and PrEP) has been reported (7).

The COVID-19 pandemic has negatively impacted efforts to expand HIV testing, including extensions associated with the EHE initiative. Significant reductions in testing and new diagnoses suggest that joint efforts are needed at the local, state, and national levels to increase testing rates among all individuals, especially those populations most affected by HIV, in line with the EHE objectives. HIV self-testing is another option for testing outside of health facilities, and is an effective, appropriate, and accurate way to diagnose HIV infection. HIV by other modalities (8). The distribution of self-testing has expanded since 2020 and may have replaced some of the common sources of testing in the United States during a pandemic (9).

The findings in this report are subject to at least three limitations. First, it cannot be determined whether the reduction in reported HIV tests and new HIV diagnoses is a result of reduced access to testing services and laboratory materials, reduced sexual behavior that would make testing unnecessary, reduced overall HIV incidence, or a combination of these and other factors. Limited evidence from MSM research indicates that sexual activity declined at the onset of the COVID-19 pandemic (10); similar data are not yet available for other populations or during later stages of a pandemic. Second, CDC NHM & E, HRSA UDS, and commercial laboratory data represent the number of tests performed, not the number of unique individuals tested; multiple tested clients could be included in the analysis. Finally, the findings of this analysis are not a comprehensive assessment of HIV testing; some test providers, including some commercial laboratories, do not report NSSPs, and self-test results are not included in this report.

To make up for the testing and diagnoses missed during the COVID-19 pandemic and accelerate the EHE initiative, partnerships between federal organizations, state and local health departments, community organizations and health care systems could increase access to HIV testing services, including self-testing. In addition, expanding routine screening in health facilities and locally tailored efforts to test HIV in non-health facilities are important aspects of the EHE initiative and its goal of reducing disparities in HIV diagnoses. **** The CDC supports the need for status-neutral approaches to health care and service delivery, which emphasizes continued engagement in HIV-related services, regardless of a person’s HIV status (4).

Acknowledgments

Shaun Chapman, Kirsten Argueta and Rebecca Levine, Office of Primary Health Care, Directorate of Health Resources and Services.

1Department of HIV Prevention, National Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention, CDC. See the article : Business Intelligence – how New York’s jets and their corporate partners have evolved.

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References

TABLE. Comparison of HIV testing and diagnosis data from four data sources — United States, 2019 and 2020

Abbreviations: ab = antibody; ag = antigen; BPHC = Institute of Primary Health Care; HRSA = Directorate for Health Resources and Services; NHM & amp; E = National Monitoring and Evaluation of HIV Prevention Programs; NHSS = National HIV Surveillance System; NSSP = National Syndrome Control Program; STD = sexually transmitted disease; TB = tuberculosis. * NSSP is cooperation between CDCs; local and state health services; and federal, academic, and private sector partners (https://www.cdc.gov/nssp/index.html). Data were extracted from two laboratory data sources for all test orders with an order or result containing “56888-1” within the reported logical observation identifier names and codes, indicating HIV-1 or HIV-2 antigen or antibody test recommended for HIV screening. The performance period during which the CDC and laboratories provided HIV testing data began on February 3, 2019. † Number of HIV tests performed; the number of new diagnoses was extracted from the reporting tables of the Unified Data System of the HRSA Health Center Program. https://data.hrsa.gov/tools/data-reporting/program-data§ CDC analyzes and disseminates data on CDC-funded HIV tests received from the NHM & E Data Reporting System (EvaluationWeb), reported by 60 funded by by the CDC’s health departments and 100 CDC-funded community organizations. The number of HIV tests and new diagnoses reported during 2019-2020 from health and non-health facilities is summarized from 2019 (https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv- godisnje-HIV -testing-report-2019.pdf) and 2020 (https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv-annual-hiv-testing-report-2020. On the same subject : New pediatric mental health services are now available to primary care providers throughout the state.pdf) NHM & amp; E Annual reports on HIV testing. An HIV test is defined as a sequence of ≥1 HIV tests performed to determine a person’s HIV status. Total HIV tests included only tests with a negative or positive result atima; tests with inconsistent or inconclusive results were excluded. New diagnoses were defined according to per sons who received a positive result of the current HIV test who had no indication of a previous positive test result. Health facilities included sexually transmitted disease clinics, community health centers, emergency departments, correctional clinics, primary health care clinics, addiction treatment facilities, pharmacies, dental clinics, TB clinics, and inpatient hospitals. Non-health facilities included HIV testing sites, community settings, non-health care facilities, field visits to health departments, and syringe servicing programs. preliminarily defined positive test results; additional testing was not required to confirm the HIV diagnosis. ** https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html†† To make the number of NSSPs comparable, “Observed, 2019” refers to February 3 – December 31, 2019 and “Observed 2020.” includes February 1 – December 31, 2020.

FIGURE 1. Weekly HIV screening tests* reported by two commercial laboratories — National Syndromic Surveillance Program,† United States, February 3, 2019–December 26, 2020§

* Data were extracted from two laboratory data sources for all test orders with an order or result containing “56888-1” within the reported logical observation identifier names and codes, indicating HIV-1 or HIV-2 antigen or antibody test recommended for HIV screening and summed according to the surveillance week from 3 February 2019 (2019, week 6) to 26 December 2020 (2020, week 52). The performance period during which CDC and laboratories provided HIV testing data began on February 3, 2019.

† The National Syndrome Monitoring Program is a collaboration between the CDCs; local and state health services; and federal, academic, and private sector partners. https://www.cdc.gov/nssp/index.html

§ Data collection began on February 3, 2019.

FIGURE 2. Absolute numbers and percent change in total number of CDC-funded HIV tests,* by race and ethnicity,† and population group§ in non–health care settings¶ — United States, 2019 and 2020

Abbreviations: AI / AN = American Indians or Alaska Natives; The. = heterosexual; IDU = injecting drug use; MSM = men who have sex with men; NHM & amp; E = Monitoring and evaluation of the national HIV prevention program; NH / OPI = Indigenous Hawaiian or other Pacific Islanders.

* Summarized from 2019 (https://www.cdc.gov/hiv/pdf/library/reports/cdc-hiv-annual-HIV-testing-report-2019.pdf) and 2020 (https: // www. cdc .gov / hiv / pdf / library / reports / cdc-hiv-annual-hiv-testing-report-2020.pdf) NHM & amp; E Annual HIV Testing Reports. An HIV test is defined as a sequence of ≥1 HIV tests performed to determine a person’s HIV status. Aggregate tests include only tests with negative or positive results (excludes tests with inconsistent or inconclusive results).

† Categories of race and ethnicity include Hispanics and Latinos of any race; more races; and American Indians or Alaskan natives, Asians, blacks, Indigenous Hawaiians or other Pacific islanders, and whites.

§ Population groups are hierarchically assigned based on self-reported behavior and gender identification. In this figure, the MSM group includes drug-injecting MSM and MSM; the transgender group includes transgender people and transgender people who inject drugs.

¶ Limited to non-health facilities because NHM & E population group data are required for all CDC-funded tests performed in non-health facilities, but are only required for HIV-positive test results in health facilities. Non-health facilities include HIV testing sites, community settings, non-health care facilities, field visits to health departments, and syringe programs.

Suggested citation for this article: DiNenno EA, Delaney KP, Pitasi MA, et al. HIV testing before and during the COVID-19 pandemic – United States, 2019-2020 MMWR Morb Mortal Wkly Rep 2022; 71: 820–824. DOI: http://dx.doi.org/10.15585/mmwr.mm7125a2.

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