Assessing the Impact of COVID-19-Related Behavioral Changes and Clinical Service Disruptions on the HIV Epidemic in the United States Restricted; Files Only
Mann, Laura (Fall 2023)
Abstract
HIV is a major public health challenge that has become more complex because of the COVID-19 pandemic. Economic and social disruptions from the pandemic have created new challenges in the control of HIV, prompting major behavioral changes and disrupting access to HIV screening, prevention, and clinical care services. This dissertation aimed to assess the impact of these COVID-related changes on the US HIV epidemic and to identify how potential home-based HIV prevention interventions that provide an alternative to clinic-based HIV services could have offset some of the COVID pandemic’s epidemiologic impact on HIV.
In Aim 1, we described the magnitude, timing, and variation of sexual distancing and HIV service utilization changes among MSM in the US during the COVID-19 pandemic. Our results were consistent with prior studies demonstrating population-level decreases in sexual behavior, interruptions to use of HIV prevention services, but limited changes to HIV medical care for persons living with HIV. We newly identified the persistence these changes through the end of 2020 into 2021, demonstrating the durable impact of the COVID pandemic on HIV-related behavior and services.
In Aim 2, we used a dynamic network-based HIV transmission model of US MSM to estimate the incidence of HIV during the COVID-19 pandemic. We found that HIV transmission among US MSM decreased during 2020, but that temporary decreases in HIV incidence during the pandemic did not lead to long-term decreases in HIV transmission.
In Aim 3, we used a dynamic network-based HIV transmission model of Atlanta MSM to assess the potential impact that home-based HIV prevention interventions could have had during the COVID pandemic. We demonstrated that although home-based PrEP retention and HIV testing interventions could be effective at increasing PrEP use and HIV testing, in isolation they would have minimal impact on pandemic-era population-level HIV incidence. Scaling up interventions in terms of coverage, length, post-intervention persistence, increasing their efficacy, or combining them with other home-based HIV prevention interventions could aid in increasing their impact on HIV transmission in a pandemic context.
The findings of this dissertation contribute to the overall understanding of how the COVID pandemic has impacted the US HIV epidemic. We found that though the pandemic affected sexual behavior and HIV prevention service use of US MSM, the combined effects of these changes were likely not significant enough to cause long-term effects to the US HIV epidemic’s trajectory. While home-based HIV prevention interventions could play a role in increasing PrEP use and HIV testing among MSM, these interventions by themselves may not have substantial impacts on HIV transmission in a pandemic context.
Table of Contents
Chapter 1. Background and Significance
Chapter 2. The Magnitude, Timing, and Variation of Sexual Distancing and HIV Service Utilization Changes among MSM in the US During the COVID-19 Pandemic
Chapter 3. Estimation of the Incidence of HIV among US MSM During the COVID-19 Pandemic in the Presence of Competing Forces of Sexual Distancing and Clinical Service Interruptions
Chapter 4. Assessing the Epidemiologic Impact of Home-Based HIV Prevention Interventions During the COVID-19 Pandemic
Chapter 5. Public Health Implications
Appendix. Technical Appendix for Chapters 3 and 4
References
About this Dissertation
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File download under embargo until 10 January 2026 | 2023-11-11 21:38:23 -0500 | File download under embargo until 10 January 2026 |
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