Boston Medical Center researchers have found that testing for sexually transmitted infections (STI) and human immunodeficiency virus (HIV) declined during the COVID-19 pandemic, despite an increase in positive test rates.
Their study, published this week in AIDS Patient Care and STDs, furthers the understanding of how the pandemic affected infectious disease screening in safety-net hospitals, which typically serve a disproportionately high number of uninsured and low-income patients.
In April 2020, the Centers for Disease Control and Prevention (CDC) made recommendations designed to reduce COVID-19 transmission and limit in-person visit volume. They recommended prioritizing symptomatic treatment, while deferring routine asymptomatic screening. Routine visits for preventive care, elective procedures, and chronic conditions decreased sharply during the height of the pandemic. An estimated 150,000 STI and HIV tests were missed during the first few months of the pandemic, and testing did not return to pre-pandemic rates for another year.
The changes prompted concern about the resulting downstream consequences of this large-scale decline in HIV and STI testing and prevention. Researchers sought to find out whether the COVID-19 pandemic had significant and inequitable health impacts on already marginalized populations.
Their study at Boston Medical Center was located in an area of high incidence of chlamydia and syphilis. The study researchers collected data on chlamydia, gonorrhea, syphilis, and HIV testing rates and results from a hospital-wide database. The study was divided into three periods: pre-pandemic (July 2019-February 2020), peak pandemic (March 2020-May 2020), and post-peak pandemic (June 2020-August 2021).
They found a significant drop in testing rates during March 2020. STI testing during peak pandemic was down 42% from the pre-pandemic baseline period, and peak pandemic HIV testing rates were 43% of pre-pandemic rates.
Prior to the COVID-19 pandemic, Black and Hispanic populations experienced a disproportionate share of new STIs, as compared to their white peers, driven by inequitable access to healthcare and sexual networks characteristics, rather than by differences in sexual behavior, the researchers found.
In already vulnerable communities where patients faced disproportionate baseline HIV and STI rates, the consequences of inadequate STI and HIV screening were likely more profound, due to the compound effects of poverty, structural racism, and pandemic impacts.
The researchers said they hope to see their findings used as a call to action for providers to introduce alternatives to traditional office-based STI and HIV testing, and for greater investment in public health infrastructure.
“The results of this study highlight the insufficient screenings and lack of healthcare experienced by vulnerable populations during the pandemic,” Dr. Tyler Lescure, lead author and a Boston Medical Center internal medicine resident, noted in a statement. “High levels of STI transmission and lack of adequate testing can lead to future infectious disease crises, so early diagnosis is critical in reducing the individual and community impacts of these infections.”