The Impact of COVID-19 on HIV testing in the UK's First Fast-Track HIV City

Rhys D Wenlock; Chante Shillingford; John Mear; Duncan Churchill; Jaime H. Vera; Gillian Dean

Disclosures

HIV Medicine. 2022;23(7):790-796. 

In This Article

Abstract and Introduction

Abstract

Objectives: To describe the impact that the COVID-19 pandemic has had on HIV testing in Brighton and Hove, United Kingdom.

Methods: All HIV tests performed in Brighton and Hove from January 2016 to June 2021 were extracted, de-duplicated and anonymized. Analysis was performed to compare the monthly numbers of tests and diagnoses before and during the pandemic across different services.

Results: The number of patients having tests for HIV in sexual health services (SHS) decreased by 64% in April 2020, followed by a recovery to baseline levels by the start of 2021. Similarly, the monthly number of diagnoses decreased drastically after April 2020, with almost half of diagnoses made by SHS in 2020 occurring in the three pre-pandemic months of the year. 'Self-sampling', used more by women and younger patients, has contributed significantly to the recovery.

The number of patients tested in secondary care was seemingly unaffected by the pandemic. However, testing numbers were reduced in specialist services, whereas in the emergency department (ED) testing increased four-fold (most notably in the elderly) without finding any cases.

General practice saw decreases in both the number of HIV tests performed and the number of new diagnoses made, which had not returned to baseline by June 2021.

Discussion: The COVID-19 pandemic has had a large impact on the number of HIV tests performed in Brighton and Hove with sizeable decreases in the number of patients tested likely leading to 'missed' diagnoses. By June 2021 testing had still not returned to normal across the city.

Introduction

The COVID-19 pandemic has caused more than 5.3 million deaths (as of 16 December 2021) and has threatened health systems globally. The UK went into a national lockdown on the 26 March 2020, with some social distancing regulations in place for the next 15 months until all restrictions were lifted on the 21 June 2021.[1] Out of necessity, the UK's National Health Service underwent significant adaptation, and its staff were redeployed to accommodate the enormous strain placed upon it. The collateral damage imposed on the UK's health by the pandemic, and the response to it, is still coming to light.

Early during the pandemic, groups raised concerns of the potential direct and indirect impacts of COVID-19 on health.[2] Evidence is accumulating that in 2020 fewer patients attended emergency departments (EDs),[3–5] fewer presented with myocardial infarctions,[6] fewer elective operations were performed[7] and avoidable deaths due to delays in diagnosing cancer are predicted.[8] Similarly, services providing care for sexually transmitted infections (STIs) have also been negatively impacted.[9–14]

There is literature suggesting a lower incidence of gonorrhoea, chlamydia and syphilis in cities around the world during 2020, with some reporting an 81% decrease.[9–11] This could be attributed to a decreased availability of testing leading to 'missed diagnoses'[12] or a decrease in transmission due to social distancing rules.[13] By contrast, other published work demonstrates a higher incidence of STIs in 2020, highlighting the importance of understanding local context and epidemiology.[14,15]

However, no studies have reported in detail the impact of the COVID-19 pandemic on HIV testing in high-income countries. This has particular significance for HIV as delayed diagnosis can lead to onward transmission in the absence of obvious symptoms[16] and increased morbidity.[17] Hitherto, most of the studies investigating STIs either relied on national mandatory reporting of diagnoses, which may be unable to provide information on access to testing, or were based on single-centre sexual health services (SHS) studies. Understanding the potential impact on Brighton and Hove is important as it has the highest HIV prevalence in the UK outside of London, at 7.94/100 000 persons.[18] Here, we aim to use a unique dataset of all HIV tests processed at a city-wide laboratory to provide insights into the impact of the COVID-19 pandemic on HIV testing across a whole city.

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