Data Show Drop in Sexual Health Services for HIV, STIs, Hepatitis in England

A new report from the CDC details how services for HIV, sexual health, and viral hepatitis in England were adversely affected in the aftermath of the COVID-19 pandemic by the reallocation of health care staff, as well as the introduction of social and physical distancing measures in March 2020. Data from 2019 and 2020 were compared.

Among the items most affected by the pandemic, the new report in Emerging Infectious Diseases details, were testing for sexually transmitted infections (STIs), HIV, and hepatitis; in-person services, such as vaccination; treatment for hepatitis C infection (HCV); and equal access to care resulting from the switch to remote services.

“In England, surveillance of STIs, HIV, and hepatitis relies on patient-level data on consultations, tests, diagnoses, vaccinations, treatment, and outcomes from sexual health services (SHS), general practitioners, hospital outpatient clinics, and drug treatment centers,” the authors wrote. “Given the disruption in routine reporting in 2020, when possible, we analyzed data from clinics and laboratories who provided complete reports for January–September in both 2019 and 2020."

Overall, the testing numbers bear out a precipitous drop: 77% and 71% decreases were seen in testing for HIV and STIs, respectively, from January through April 2020. When looking at January to September 2020, the numbers show drops of just 36% and 28%, respectively—but these were still lower than the same period in 2019.

In contrast, online access to self-testing kits between April and September 2020 accounted for more than 63% of HIV and more than 51% of STI tests ordered compared with 25% and 22%, respectively for the same period in 2019—with individuals receiving their results via text message, email, letter, or online.

When age and sexual identity were considered, the following results were seen for HIV and STI testing:

• By age grouping, rates declined the most for persons aged 15 to 19 years and 45 years and older, from January to April 2020 vs persons aged 20 to 44 years; these age groups also had the slowest returns to prepandemic testing levels from June to September 2020
• By sexual orientation, heterosexual or bisexual women and heterosexual men had the largest proportional declines in testing vs men who have sex with men (MSM) and lesbian and other women who have sex exclusively with women; heterosexual men had the slowest recovery to prepandemic levels
• By race, Asians, Blacks, and other had the steepest declines in testing; recovery to prepandemic levels was slowest among Blacks

Testing rates for hepatitis A (HAV), hepatitis B (HBV), and HCV declined 63%, 61%, and 74%, respectively, from January to April 2020, with testing for HCV remaining 58% lower in September 2020 vs 2019. For hepatitis infection testing in the community, there was almost a complete dropoff: 98%.

As with the testing rate decreases, resultant diagnoses saw drops as well:

• Bacterial STI positivity: 12% in January 2020
• HBV and HCV positivity: from 0.8% to 0.4% and 2.8% to 1.4%, respectively, from January to April 2020
• HIV positivity: from 0.10% to 0.09% for September 2019 vs 2020, respectively

Partial recoveries were seen with the STI and hepatitis positivity rates, but these were mixed and 2020 rates still remained below those from 2019 for the early part of the years. As for the HIV positivity rates, these remained consistently high for most of 2020, peaking at 0.20% in April 2020, before the September drop.

Vaccination rates were also affected, as seen by first doses among MSM. There was a 97% drop for HAV and human papillomavirus (HPV) and a 96% drop for HBV—both from January through April 2020. Again, despite a reported May 2020 increase, overall rates by September 2020 were still lower vs 2019 for HAV, HBC, and HPV—each by more than 50%.

For HCV treatment initiation, September 2020 saw levels 27% lower vs the same month in 2019. Drug services and prisons had the largest declines in HCV treatment referrals.

The report authors wrote that their findings are backed by data from staff and peer-support surveys and community drug treatment services, and they proposed that the drops they saw may be the result of reduced exposure, “leading to fewer opportunities for socializing and meeting sexual partners.” However, there is cause for concern in this, especially for HCV, as treatment interruption can lead to a higher risk of long-term adverse effects, the authors noted.

Moving forward, they urged for study on how the switch to remote services may have contributed to health inequalities, particularly for socially disadvantaged and excluded groups and minority populations. Plans may also need to be formulated for persons who inject drugs, as they are at a greater risk of harm and bloodborne viruses.

Reference

Mitchell HD, Vilaplana TG, Mandal S, et al. Effects of COVID-19 pandemic response on service provision for sexually transmitted infections, HIV, and viral hepatitis, England. Emerg Infect Dis. 2022;28(3):739-742. doi:10.3201/eid2803.211998