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COVID-19 affects Ryan White facility utilization in South United States: a place visitation analysis

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BACKGROUND: Few studies on HIV services utilization interruption in Deep South, US which endures double epidemic of HIV and COVID. Using real-time place visitation data of Ryan White (RW) facilities in 8 South states (3/13/2019-6/30/2021) we aim to explore spatiotemporal pattern of the HIV-related health utilization since the pandemic.
METHODS: The address of all RW facilities in the 8 states (i.e., Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas) were retrieved from the HRSA dataset. The place visitation data of all RW facilities (i.e., how many people visit a certain clinic [given a location address] in a particular timepoint) were obtained from cellphones via SafeGraph, a commercial data company. We calculated the daily (and 7-day smoothed) visitation change rate (VCR) using the same day of the week for year 2020 to 2019 and 2021 to 2019. Temporal pattern of RW facility visitation change was presented by VCR trajectories (Fig 1.a) of states and geospatial pattern was showed by map
(Fig 1.b).
RESULTS: The VCR trajectories kept declining since WHO declared COVID-19 a pandemic to April for most of states and then stably increased till June 2020. However, the recovery of visitation volume was significantly interrupted in 2020-2021 winter. The visitation volume in most states (except SC) remained low and did not achieve the level prior to the pandemic with the state VCR ranging -28.3% to -48.3% in 2020 and -21.2% to -48.8% in 2021. Facilities with high VCR were concentrated in FL, GA, and TX.


CONCLUSIONS: Based on real-time place visitation data, our study suggests that RW facility utilization in Deep South has been severely affected by COVID-19 and not yet recovered for most of states. Policy makers and health organizations need to pay attention to the profound and long-term impact of the pandemic on HIV service utilization in Deep South.