The impact of disruptions due to COVID‐19 on HIV transmission and control among men who have sex with men in China

  1. Ross D Booton
  2. Gengfeng Fu
  3. Louis MacGregor
  4. Jianjun Li
  5. Jason J Ong
  6. Joseph D Tucker
  7. Katherine ME Turner
  8. Weiming Tang
  9. Peter Vickerman
  10. Kate M Mitchell

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Abstract

Introduction

The COVID‐19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV‐related mortality. We estimated how COVID‐19‐related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China, over a one‐ and five‐year time horizon.

Methods

Regional data from China indicated that the number of MSM undergoing facility‐based HIV testing reduced by 59% during the COVID‐19 pandemic, alongside reductions in ART initiation (34%), numbers of all sexual partners (62%) and consistency of condom use (25%), but initial data indicated no change in viral suppression. A mathematical model of HIV transmission/treatment among MSM was used to estimate the impact of disruptions on HIV infections/HIV‐related deaths. Disruption scenarios were assessed for their individual and combined impact over one and five years for 3/4/6‐month disruption periods, starting from 1 January 2020.

Results

Our model predicted new HIV infections and HIV‐related deaths would be increased most by disruptions to viral suppression, with 25% reductions (25% virally suppressed MSM stop taking ART) for a three‐month period increasing HIV infections by 5% to 14% over one year and deaths by 7% to 12%. Observed reductions in condom use increased HIV infections by 5% to 14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility HIV testing and ART initiation, but reduced partner numbers resulted in 11% to 23% fewer infections and 0.4% to 1.0% fewer deaths. Longer disruption periods (4/6 months) amplified the impact of disruption scenarios. When realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections occurred over one year (3% to 17%), but not for five years (1% increase to 4% decrease), whereas deaths mostly increased over one year (1% to 2%) and five years (1.2 increase to 0.3 decrease).

Conclusions

The overall impact of COVID‐19 on new HIV infections and HIV‐related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID‐19‐related disruption on HIV transmission and control among MSM in China.

Article activity feed

  1. Version published to 10.1002/jia2.25697
  2. ScreenIT

    SciScore for 10.1101/2020.10.08.20209072: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our analysis has some limitations which should be acknowledged. Not all of the disruption estimates were MSM specific, and MSM may have had more substantial disruption when compared to other populations (MSM facility testing was reduced by 59%, compared to 29% for the entire population [17]). Therefore, we may have underestimated the disruption to ART initiations. The survey data only gave semi-quantitative estimates of disruptions to partnerships and condom use i.e. proportion of MSM having fewer partners and not the overall reduction in partner numbers. We accounted for this by exploring uncertainty in the reduction and sampling from a wider distribution of estimates. Further, the disruption estimates for testing/ART initiations/VS came from Jiangsu, different to the cities we model (Guangdong/Shandong), and estimates for disruptions to partner numbers/condom use came from 31 provinces, meaning we may not have fully captured the impact of COVID-19 in each city. Finally, we have not modelled the direct impacts of COVID-19 infection. Future extensions work could include modelling the potential characteristics of co-infection between HIV and COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.10.08.20209072v1 on medRxiv