How Were HIV Care Services in South Carolina Interrupted by the COVID-19 Pandemic?

Results from a recent study out of South Carolina, which examined how its HIV service care continuum was affected by the coronavirus disease 2019 pandemic (COVID-19), show that more than a quarter (26%) of HIV clinics had to shut their doors completely and over half (56%) experienced partial service interruptions, reports the study in AIDS and Behavior.

“The current study is one of the first efforts to examine the disparity of HIV service interruption and identified the socioeconomic correlates of this disparity,” the authors noted, adding that no empirical studies have looked into these outcomes yet.

The authors examined data from 27 HIV care clinics in 46 counties, funded through the Ryan White HIV/AIDS Program, based on reports submitted to South Carolina’s Department of Health and Environmental Control. Service interruptions were classified by clinic operation hours, HIV service coverage, telehealth use, and health care provider availability, and divided into 4 categories:

1. Complete: did not meet any of the classification criteria
2. Partial: failed in 2 or 3 of the criteria
3. Minimal: failed in any 1 of the criteria
4. No interruption: met all 4 criteria

Results show that most clinics (55.6%) had a partial interruption of services; 3 (11.1%), minimal interruption; 2 (7.4%), no interruptions; and 25.9%, complete interruption. Clinics limited office hours and face-to-face visits, reduced hours, adjusted schedules, discontinued home visits and support groups, suspended walk-in services, made prevention services available by appointment only, moved HIV testing services to alternate locations, and instituted flexible work schedules for staff.

Not all service interruptions were bad, however, in that all of the clinics took measures to protect everyone who passed through their doors from COVID-19. These included temperature and symptom screenings, requiring face masks, and ensuring social distancing. One of the clinics also provided drive-up COVID-19 testing, while 2 others added medication delivery, personal pantry, and housing support to their armamentarium.

Telehealth and mobile apps were also introduced, but with mixed results. Not all of the clinics were able to adjust their service offerings so quickly and not all patients had home internet access. This is an area in which the authors recommended additional studies that address barriers to scaling up service offerings during public health emergencies.

The study had 3 primary objectives:

• Examine how HIV services were interrupted
• Pinpoint patterns of service interruption, by county
• Identify disparities that could have contributed to care disruption (eg, insurance coverage, socioeconomic status [SES])

Geolocations and zip codes were used to determine county; AIDSVu.org provided the numbers for people living with HIV (PLWH) per 100,000 in 2018; and SES indicators (poverty, high school education, median household income, Gini Coefficient, uninsured status) came from the Census Bureau.

Overall, there was not a positive correlation between HIV service interruption and number of COVID-19 cases despite the geospatial distribution patterns of confirmed cases of COVID-19 and PLWH being similar. However, insurance status was highlighted as a significant factor affecting receipt of HIV services during this time (F = 3.987; P = .02).

Additional results show the following:

• HIV service interruption did not overlap with COVID-19 case density.
• PLWH and COVID-19 cases as of June 13, 2020, averaged 429 and 416, respectively, in the areas served by HIV clinics.
• Median (SD) household income was $43,124 ($5367).
• Mean of Gini coefficients was 0.46.
• 13.5% of the population was uninsured.
• 20% were living in poverty.

“The disparity of HIV service interruption during a public health crisis such as COVID-19 is an important issue for the healthcare systems and policy makers to consider as such interruption may further amplify the disparities in HIV treatment cascade in settings with a significant HIV burden or among various vulnerable populations,” the authors concluded. “To prevent the further widening of the disparities in existing HIV care system, strengthening and empowering community partners of HIV clinics could be essential for more effective and accountable responses to public health emergencies.”

South Carolina is 1 of the 7 states that are the focus of the US government’s Ending the HIV Epidemic: A Plan for America, due to its high burden of HIV cases in the rural population.

Reference

Disparity in HIV service interruption in the outbreak of COVID-19 in South Carolina. AIDS Behav. Published online August 27, 2020. doi:10.1007/s10461-020-03013-x