Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis

Matthew A Spinelli; Noelle Le Tourneau; David V Glidden; Ling Hsu; Matthew D Hickey; Elizabeth Imbert; Mireya Arreguin; Jennifer P Jain; Jon J Oskarsson; Susan P Buchbinder; Mallory O Johnson; Diane Havlir; Katerina A Christopoulos; Monica Gandhi

doi:10.1093/cid/ciac179

Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis

Clin Infect Dis. 2022 Aug 24;75(1):e947-e954. doi: 10.1093/cid/ciac179.

Authors

Affiliations

¹ Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
² Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
³ San Francisco Department of Public Health, San Francisco, California, USA.
⁴ Department of Psychiatry, University of California, San Francisco, California, USA.
⁵ Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, USA.

Abstract

Background: After coronavirus disease 2019 (COVID-19) shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net human immunodeficiency virus (HIV) clinic in San Francisco, particularly among people living with HIV (PLWH) who are experiencing homelessness. We sought to determine if proactive outreach to provide social services, scaling up of in-person visits, and expansion of housing programs could reverse this decline.

Methods: We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression followed by interrupted time series (ITS) analysis to examine changes in the rate of VS per month. Loss to follow-up (LTFU) was assessed via active clinic tracing.

Results: Data from 1816 patients were included; the median age was 51 years, 12% were female, and 14% were experiencing unstable housing/homelessness. The adjusted odds of VS increased 1.34 fold following institution of the multicomponent strategies (95% confidence interval [CI], 1.21-1.46). In the ITS analysis, the odds of VS continuously increased 1.05 fold per month over the post-intervention period (95% CI, 1.01-1.08). Among PLWH who previously experienced homelessness and successfully received housing support, the odds of VS were 1.94-fold higher (95% CI, 1.05-3.59). The 1-year LTFU rate was 2.8 per 100 person-years (95% CI, 2.2-3.5).

Conclusions: The VS rate increased following institution of the multicomponent strategies, with a lower LFTU rate compared with prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.

Keywords: COVID-19; HIV virologic suppression; homelessness; housing support; telemedicine.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

COVID-19*
Female
HIV
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Ill-Housed Persons*
Interrupted Time Series Analysis
Male
Middle Aged
Pandemics

Abstract

Publication types

MeSH terms

Grants and funding