The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

• Type of Material: Article
• Authors: Xiao Zang, Brown University; Emanuel Krebs, British Columbia Centre for Excellence in HIV/AIDS; Siyuan Chen, Simon Fraser University; Micah Piske, British Columbia Centre for Excellence in HIV/AIDS; Wendy Armstrong, Emory University; Czarina N. Behrends, Weill Cornell Medical College; Carlos del Rio, Emory University; Daniel J. Feaster, University of Miami; Brandon D. L. Marshall, Brown University; Shruti H. Mehta, Johns Hopkins University; Jonathan Mermin, Centers for Disease Control and Prevention; Lisa R. Metsch, Columbia University; Bruce R. Schackman, Weill Cornell Medical College; Steffanie A. Strathdee, University of California San Diego; Bohdan Nosyk, British Columbia Centre for Excellence in HIV/AIDS
• Language: English
• Date: 2021-06-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciaa1547
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Volume: 72
• Issue: 11
• Start Page: E828
• End Page: E834
• Grant/Funding Information: This work was supported by US NIH-NIDA (grant number: R01-DA041747).
• Keywords: Microbiology; Immunology; Life Sciences & Biomedicine; HIV; Science & Technology; RECOMMENDATIONS; Infectious Diseases; HEALTH; dynamic HIV transmission model; COVID-19; linked opt-out HIV testing; cost-effectiveness
• Research Categories: Biology, Microbiology; Health Sciences, Immunology; Health Sciences, Public Health; Biology, Virology

Abstract

Background: Widespread viral and serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a unique opportunity to also test for human immunodeficiency virus (HIV) infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on the HIV incidence and the cost-effectiveness of this strategy in 6 US cities. Methods: Using a previously calibrated dynamic HIV transmission model, we constructed 3 sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviors at discrete levels between 0%-50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%-90% of the adult population in addition to Scenario 2. We estimated the cumulative number of HIV infections between 2020-2025 and the incremental cost-effectiveness ratios of linked HIV testing over 20 years. Results: In the absence of linked, opt-out HIV testing, we estimated a total of a 16.5% decrease in HIV infections between 2020-2025 in the best-case scenario (50% reduction in risk behaviors and no service disruptions), and a 9.0% increase in the worst-case scenario (no behavioral change and 50% reduction in service access). We estimated that HIV testing (offered at 10%-90% levels) could avert a total of 576-7225 (1.6%-17.2%) new infections. The intervention would require an initial investment of $20.6M-$220.7M across cities; however, the intervention would ultimately result in savings in health-care costs in each city. Conclusions: A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce the HIV incidence and reduce direct and indirect health care costs attributable to HIV.