HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL
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HIV Care Continuum and COVID‑19 Outcomes Among People Living with HIV During the COVID‑19 Pandemic, Chicago, IL Jessica P. Ridgway1 · Jessica Schmitt1 · Eleanor Friedman1 · Michelle Taylor1 · Samantha Devlin1 · Moira McNulty1 · David Pitrak1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
The COVID-19 pandemic has the potential to lead to serious negative health outcomes for people living with HIV (PLWH). Besides the risk of COVID-19 disease itself, the indirect effects of the pandemic including shelter-in-place orders, record unemployment, and widespread social anxiety may interact synergistically to worsen health outcomes for PLWH [1, 2]. In this report, we share the experience from University of Chicago Medicine regarding the early impact of the COVID-19 pandemic on PLWH in regards to retention in care, antiretroviral adherence, and COVID-19 testing and clinical outcomes.
Retention in Care Retention in care is essential for the health of PLWH and for public health [3]. Patients who are retained in care are more likely to adhere to antiretroviral therapy and experience improved health outcomes, and are less likely to transmit HIV to others [4]. Missed medical appointments are independently associated with increased risk of AIDS-defining illnesses and death [5, 6]. Traditionally, retention in care has relied on the ability of PLWH to regularly attend in-person appointments with their HIV medical team, which is difficult during the COVID-19 pandemic. To slow the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) has strongly encouraged social distancing [7] and many U.S. state governments have imposed shelter-in-place or “lockdown” orders [8–10]. In response, the HRSA Ryan White Program has encouraged the use of telehealth to allow PLWH to stay home and not travel to clinics for HIV care visits [11], and many HIV * Jessica P. Ridgway [email protected] 1
Department of Medicine, University of Chicago, Chicago, IL, USA
medical providers have moved to virtual medical visits utilizing telephone calls or online video conferencing services. While virtual visits are helpful for some PLWH [12, 13], others may may not have reliable internet or mobile phone services to utilize these services [14]. Moreover, during the pandemic, many Infectious Diseases physicians and clinics are overwhelmed with COVID-19 patients, and lack the time or resources to respond to PLWH who may have additional needs or concerns during this time. Services and resources which in ordinary times are easily available may have been discontinued, with effects on reengagement in care and extension of prescriptions. Even if telephone or video conferencing visits are occurring, these visits may lack wrap around services provided by social workers and other HIV care team members. Our medical center serves a predominantly African American population from economically disadvantaged areas on the south side of Chicago and is a major provider of HIV care in our community [15].
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