The COVID-19 pandemic impacted human immunodeficiency virus testing at anonymous consultation clinics in North-Rhine Westphalia state - Germany, 2013-2021

  • Sexually Transmitted Diseases
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During the COVID-19 pandemic, anonymous sexual health consultation clinics run by local health authorities in German state North-Rhine Westphalia (NRW) operated at reduced capacity.

We examined changes to human immunodeficiency virus (HIV) testing patterns from January 2013 to December 2021 to investigate the impact of the COVID-19 pandemic on HIV testing in NRW.

We analysed monthly HIV testing data from all 53 anonymous consultation clinics in NRW. We assessed HIV testing volume and test positivity per 1,000 tests by high-risk groups (men who have sex with men (MSM), sex workers, and people who inject drugs (PWID). We used Pearson's chi-squared test to assess the change in testing volume and test positivity and to compare differences between high-risk groups during the COVID-19 pandemic (2020 and 2021) and a corresponding pre-pandemic (2019) period.

During 2013-2019, the volume of HIV tests in MSM and PWID increased but remained constant for sex workers, with correspondingly 2,846 (+153%), 99 (+225%), and 86 (+5%) more tests conducted between 2013 and 2019. During the same period, test positivity changed in MSM, PWID and sex workers by -38.1 (-75%), -15.7 (-69%), and -3.7 (-68%) per 1,000 tests, respectively.

Compared to 2019, the number of HIV tests performed during pandemic years declined by 66% in PWID and sex workers and by 43% in MSM (p<0.05). An increase in test positivity was observed in all risk groups; however, it did not meet the significance threshold (p-value of <0.05).

During the first two pandemic years, overall test volume in risk groups was more than halved, and the evidence about test positivity change is inconclusive.

We recommend ongoing monitoring of HIV testing patterns to inform services and scaling up the total number of tests in all risk groups to account for likely missed cases during the HIV testing disruption.

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