HIV Testing by Public Health Centers and Municipalities and New HIV Cases During the COVID-19 Pandemic in Japan

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Abstract

During the COVID-19 outbreak, facility capacity for HIV testing has been limited. Furthermore, people may have opted against HIV testing during this period to avoid COVID-19 exposure. We investigated the influence of the COVID-19 pandemic on HIV testing and the number of reported HIV cases in Japan.

Methods:

We analyzed quarterly HIV/AIDS-related data from 2015 to the second quarter of 2020 using an anomaly detection approach. The data included the number of consultations, the number of HIV tests performed by public health centers or municipalities, and the number of newly reported HIV cases with and without an AIDS diagnosis. We further performed the same analysis for 2 subgroups: men who have sex with men (MSM) and non-Japanese persons.

Results:

The number of HIV tests (9,584 vs. 35,908 in the year-before period) and consultations (11,689 vs. 32,565) performed by public health centers significantly declined in the second quarter of 2020, whereas the proportion of new HIV cases with an AIDS diagnosis (36.2% vs. 26.4%) significantly increased after removing the trend and seasonality effects. HIV cases without an AIDS diagnosis decreased (166 vs. 217), but the reduction was not significant. We confirmed similar trends for the men who have sex with men and non-Japanese subgroups.

Conclusions:

During the COVID-19 pandemic, the current HIV testing system in Japan seems to have missed more cases of HIV before developing AIDS. Continuously monitoring the situation and securing sufficient test resources by use of self-testing is essential to understand the clear epidemiological picture of HIV incidence during the COVID-19 pandemic.

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  1. SciScore for 10.1101/2020.10.16.20213959: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableWe further extracted the data of HIV cases with and without AIDS diagnosis for the following two subgroups: men who have sex with men (MSM) and non-Japanese, because MSM accounts for about 70% of the newly reported HIV cases (12), and foreigners are considered vulnerable during disasters due to language barriers (13).

    Table 2: Resources

    Antibodies
    SentencesResources
    Anomaly detection: We applied an anomaly detection approach to those longitudinal data to identify the period when the number of HIV related consultations, HIV antibody tests, and new HIV cases with and without AIDS diagnosis were disrupted.
    HIV
    suggested: None
    Software and Algorithms
    SentencesResources
    All analyses were performed on the statistical computing software R 4.0.1 (R Development Core Team) with the library ‘anomalize’.
    R Development Core
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    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:
    A limitation of this study is that we were not able to account for the heterogeneous epidemiology of HIV between different regions. Higher HIV incidence has been observed in urban areas such as Tokyo and Osaka compared with rural areas. Thus, public health centers in urban areas have allocated budgetary resources towards HIV testing, whereas this has not been prioritized in rural areas. During the pandemic, the testing opportunities in rural areas may have declined even further than urban areas. Our study mainly focused on HIV cases with and without AIDS diagnosis and testing regardless of the patients’ characteristics. One of the concerns in this pandemic is that more vulnerable populations, such as sex workers, low-income populations, younger population, in addition to foreigners, may have experienced disproportionate harms. Further studies should focus on these populations and identify barriers to testing. We used only the number of tests performed by public health centers and municipalities, thus self-tests and home specimen collection, which are increasingly popular, and tests performed in clinics and hospitals were not counted. Further investigation is necessary to focus on these types of tests to fully understand the response of the HIV testing system to COVID-19 in Japan. We demonstrated that the uptake of HIV testing provided by public health centers and municipalities declined; further, HIV cases without AIDS diagnosis during the COVID-19 pandemic numerically decrea...

    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

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