COVID-related Excess Missed HIV Diagnoses in the United States in 2021: Follow-up to 2020

Objective COVID-19 and related disruptions led to a significant drop in HIV diagnoses in the US in 2020. Recent analyses found 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the drop in diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021. Methods We apply modified versions of previously developed methods analyzing 2021 diagnosis data from the National HIV Surveillance System to determine whether the 2021 diagnosis levels of PWH infected pre-2020 are above or below the projected pre-COVID trends. We apply these analyses on stratifications based on assigned sex at birth, transmission group, geographic region, and race/ethnicity. Results In 2021, HIV diagnoses returned to pre-COVID levels among all PWH acquiring infection 2011-19. Among Hispanic/Latino PWH and males, diagnoses returned to pre-COVID levels. White PWH, men who have sex with men, and PWH living in the south and northeast showed higher-than-expected levels of diagnosis in 2021. For the remaining populations, there were fewer HIV diagnoses in 2021 than expected. Conclusions While overall diagnoses returned to pre-COVID levels, the large diagnosis gap observed in 2020 remained unclosed at the end of 2021. Lower than expected diagnosis levels among certain populations indicates that COVID-19 related disruptions to HIV diagnosis trends were present in 2021. Although some groups showed higher-than-projected levels of diagnoses, such increases were smaller than the corresponding 2020 decreases. Expanded testing programs designed to close these gaps are essential.