Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries

  1. Amrita Rao
  2. Katherine Rucinski
  3. Brooke A. Jarrett
  4. Benjamin Ackerman
  5. Sara Wallach
  6. Julia Marcus
  7. Tyler Adamson
  8. Alex Garner
  9. Glenn-Milo Santos
  10. Chris Beyrer
  11. Sean Howell
  12. Stefan Baral

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Abstract

The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM.

Setting:

Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet . Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0–100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans.

Methods:

We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services.

Results:

A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely.

Conclusions:

More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.

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  1. Version published to 10.1097/qai.0000000000002620
  2. ScreenIT

    SciScore for 10.1101/2020.08.19.20178285: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: A total of 13,563 users provided informed consent and responded to the survey, and 12,210 completed the survey.
    IRB: The larger study was reviewed by the Johns Hopkins School of Public Health Institutional Review Board and received a Category 4 exemption.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    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:
    This study has some limitations. First, the Hornet survey is based on a convenience sample. Those who received the survey had to be active Hornet users and have used the app in the last year, implying that they had access to a smartphone and Wi-Fi or data and knowledge of the app. Those who participated in the survey had to take the time to complete the survey. Sub-Saharan Africa, a region of the world heavily affected by HIV, is not represented in our sample. While these results are very likely not representative of all MSM globally, they provide timely insights into potential disruptions to HIV prevention and treatment services. Second, between 2% and 14% of responses for the primary prevention outcome variables were missing. Complete case analysis was performed and incomplete responses were assumed to be missing completely at random (MCAR) as no discernable patterns of missingness were observed. In the case that data were missing not at random (MNAR), with the missingness due to some other variable not captured in the dataset, our effect estimates may be biased. While this is a limitation of a survey made available through an app-based platform, data were still captured on a large number of individuals and these data provide rapid insights on current access to services. Third, in this analysis we examined country-level stringency of response, but this may only provide part of the picture if there is significant heterogeneity in stringency of the response within a country, ...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.19.20178285v1 on medRxiv