HIV Testing Dropped Among Children, Adolescents During Early COVID-19

In the first 3 months of the COVID-19 pandemic, HIV testing and case identification among children and adolescents dropped in 22 countries supported by the US President’s Emergency Plan for Aids Relief (PEPFAR), according to a CDC Morbidity and Mortality Weekly Report.

The report showed that, among individuals between the ages of 1 and 14 years, HIV testing decreased by 40.1% and case identification decreased by 29.4% in certain countries in Asia, Africa, and South America.

To come to this finding, researchers assessed changes in HIV testing and diagnoses between October 1, 2019, and September 30, 2020. This timeline was divided into 4 quarters (Qs):

• Q1: October, November, December 2019
• Q2: January, February, March 2020
• Q3: April, May, June 2020
• Q4: July, August, September 2020

The report refers to Q3 as the first quarter after the pandemic began bceause COVID-19 was declared a pandemic in March 2020.

During these 4 quarters, PEPFAR supported 4,312,343 HIV tests and identified 74,658 cases of HIV in children and adolescents in 22 of 50 PEPFAR-supported countries.

The number of HIV tests performed was similar during Q1 and Q2, which had 1,268,476 and 1,313,730 tests, respectively. This number dropped 40.1% between Q2 and Q3, where only 787,548 HIV tests were accounted for. However, 942,603 tests were conducted in Q4, marking a 19.7% increase from Q3 to Q4.

Similar trends were seen in the numbers of identified HIV cases in children aged 1 to 14 years. Starting at 20,659 cases in Q1, this number rose slightly by 7.4% to 22,181, dropped by 29.4% to 15,652, and finally, slightly increased by 3.3% to 16,163 identified cases in Q4.

According to the report authors, these trends suggest the COVID-19 pandemic had a negative affect on progress towards reaching the UNAIDS 95–95–95 targets for children living with HIV. This target is that 95% of people living with HIV know their HIV status, 95% of people who know their status are receiving treatment, and 95% of people on treatment have a suppressed viral load by 2030.

Additionally, outpatient testing decreased in these countries by 21%, despite increases in mobile (38%), facility-based index (8%), and malnutrition (7%) testing strategies. The report authors suggested these other strategies can help identify children without access to health care while minimizing exposure in health care facilities.

“Case identification is the first step to ensure children living with HIV are linked to life-saving treatment, achieve viral suppression, and live long, healthy lives,” the report said. “Successful interventions to optimize pediatric HIV testing during the COVID-19 pandemic are needed to sustain progress toward achieving Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets.”

To minimize the disruption of these trends while still being in a pandemic, the authors suggested HIV testing programs continue using programmatic, surveillance, and financial data from both national and more local levels to help determine the best testing strategies.

Reference

Traub AM, Medley A, Gross J, et al. Pediatric HIV case identification across 22 PEPFAR-supported countries during the COVID-19 pandemic, October 2019-September 2020. MMWR Morb Mortal Wkly Rep. 2022;71:894-898. doi:10.15585/mmwr.mm7128a2