Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19–Related Sexual Distancing and Clinical Service Interruption

  1. Samuel M Jenness
  2. Adrien Le Guillou
  3. Christina Chandra
  4. Laura M Mann
  5. Travis Sanchez
  6. Daniel Westreich
  7. Julia L Marcus

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Abstract

Background

The global COVID-19 pandemic has the potential to indirectly impact transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories.

Methods

We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103 000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-19–related sexual distancing and service interruption within 4 service categories (HIV screening, preexposure prophylaxis, antiretroviral therapy, and STI treatment).

Results

A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM, −227 cases), but have net protective effect for STIs (−23 800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57 500 STI cases.

Conclusions

Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID-19 pandemic on the HIV/STI epidemic.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.30.20204529: (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: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Minimizing service interruption will require innovative approaches to ensure access to clinical services and overcome common barriers to care during the COVID pandemic, including travel limitations and gaps in health insurance. These approaches will remain important even as sexual health services return to pre-COVID capacity and long-lasting impacts on health care access affect re-engagement in services. Limitations: The primary limitation of our model projections is the future uncertainty about the types and durability of both sexual distancing and service reduction. While our sensitivity analysis (Figure 2) explored durability, both components may change or rebound in different ways from those modeled. Modeling changes in the COVID-19 era required mapping data on broader aggregate reductions onto individual rate-based model parameters. Future empirical research on sexual distancing and service interruption should measure these changes with more individual-level specificity within and across persons. Second, we assumed that there was no correlation between changes in individual behavior and changes in service engagement. This decision was based on a re-analysis of one published study,7 provided in Supplemental Table 4.1, showing limited evidence of such individual-level correlation between change in sexual partner numbers and change in service access (small correlations were observed for HIV and STI screening only). Additionally, some group-level age-related changes in both ...

    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.
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    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1093/infdis/jiab051
  3. Rapid Reviews Infectious Diseases

    Brooke Nichols

    Review 2: "Projected HIV and Bacterial STI Incidence Following COVID-Related Sexual Distancing and Clinical Service Interruption"

    This modeling preprint offers some plausible insights on the competing effects of decreased sexual partnership and clinical services on STI and HIV rates, though reviewers noted several assumptions that could be explicated or refined to make the model more reliable.

  4. Rapid Reviews Infectious Diseases

    Eline Korenromp, Nico Nagelkerke

    Review 1: "Projected HIV and Bacterial STI Incidence Following COVID-Related Sexual Distancing and Clinical Service Interruption"

    This modeling preprint offers some plausible insights on the competing effects of decreased sexual partnership and clinical services on STI and HIV rates, though reviewers noted several assumptions that could be explicated or refined to make the model more reliable.

  6. Version published to 10.1101/2020.09.30.20204529v2 on medRxiv
  7. Version published to 10.1101/2020.09.30.20204529v1 on medRxiv