Impact of COVID-19 on HIV testing volume and positivity in 16 countries

BACKGROUND: The COVID-19 pandemic presents many challenges to HIV testing. We aimed to describe the impact of COVID-19 and country-level COVID-19 stay-at-home policies on HIV testing services provided by a large global HIV project.
METHODS: We performed a retrospective analysis of monthly HIV testing data in 16 countries from January 2020 to September 2021. To account for differences in testing volume across countries, we calculated each county's percentage reduction/increase in testing by month compared to the average monthly country-level HIV testing volume in the first three months of 2020 (pre-COVID-19). Regression analysis was used to quantify the relationship between HIV testing volume, HIV case-finding rates, and national stay-at-home policies (from the Oxford COVID-19 government response tracker) by month.
RESULTS: HIV testing volume declined dramatically early in the pandemic, with countries averaging 37.8% and 33.1% fewer HIV tests per month in April and May, respectively. Those months also saw the highest average case-finding rates, at 16.7% and 16.0%. In the ensuing months, programs adapted to the threats and restrictions of the pandemic and demonstrated a rebound in testing volume and an overall average case-finding rate consistent with the pre-COVID-19 comparator months.
More stringent stay-at-home policies were associated with decreased HIV testing. Countries completed an average of 60.9% fewer tests during months when national policies required not leaving the house (p<0.001). Positivity of testing increased an average of 1.7% during those months (p=0.09).


CONCLUSIONS: While initial decreases in HIV testing were observed, focused testing strategies led to rapid programmatic recovery and, ultimately, HIV testing volume was maintained above pre-COVID-19 levels. Tighter stay-at-home orders were associated with decreases in testing, yet HIV case finding increased during these months. These results demonstrate the resiliency of HIV programs to adapt during the pandemic and highlight opportunities for increased emphasis on innovative strategies for HIV testing.

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