Changes in HIV Clinical Visit Frequency and Viral Suppression During and After COVID-19 Restrictions: A nested study within NA-ACCORD in the US, 2018–2021

Background Temporary COVID-19-related restrictions disrupted routine HIV care and viral load (VL) testing for people with HIV (PWH). Whether and when encounters and VL suppression returned to pre-pandemic levels remains unclear. We aimed to evaluate changes in HIV clinical encounters frequency and VL suppression from 2018 through 2021, and assess the impact of COVID-19 restriction policy. Methods Adults (≥18 years) with HIV from 12 U.S. clinical cohorts with ≥1 VL test from June 2020 to December 2021 were categorized into mutually exclusive HIV care groups: (1) in-care before restrictions, (2) new-to-care and (3) re-engaging during restrictions. Logistic regression with generalized estimating equations was used to estimate adjusted odds ratios (aOR) of unsuppressed VL (>200 copies/mL) for HIV care groups from June 2020 to December 2021. A linear mixed model evaluated associations between state-level COVID-19 policy strength (mild, moderate, or strong) and unsuppressed VL. Results Among PWH in-care (n=48,605), encounter frequency decreased sharply during early COVID-19 restrictions but returned to pre-pandemic levels by December 2020 and suppressed VL rate remained above 91%. New-to-care (n=105) or re-engaging (n=483) individuals did not increase odds of unsuppressed VL (vs. in-care, aOR=0.91 [95% CI: 0.73, 1.13]). Those living in states with strong (vs. mild, aOR=1.31 [0.93, 1.86]) COVID-19 restriction policies had increased odds of unsuppressed VL, though not significant. Conclusions HIV care encounters returned to pre-pandemic levels by late 2020, with sustained viral suppression. Prolonged COVID-19 restrictions were associated with higher risk of unsuppressed VL. HIV patients, providers, and clinics showed resilience during COVID-19 disruptions, offering lessons for future emergencies.