If every person who received a test for SARS-CoV-2, the virus that causes COVID-19, also received a rapid HIV test at the same time, up to 17% of future HIV seroconversions could ultimately be averted, according to a model of six U.S. cities that was published in Clinical Infectious Diseases.
Researchers compared different scenarios involving a range of COVID-19 impacts on HIV-related health services, personal risk behaviors (for both HIV and COVID-19), and access to linked HIV and SARS-CoV-2 testing. Their modeling sought to calculate the impact of each scenario on HIV incidence from 2020 through 2025. The model used Atlanta, Georgia; Baltimore, Maryland; Los Angeles, California; Miami, Florida; Seattle, Washington; and New York City.
The study authors calculated that, depending on the level of disruption in HIV-related services and the extent to which people reduced their risk behaviors, the introduction of opt-out testing for HIV linked to SARS-CoV-2 testing could avert anywhere from 1.6% of new HIV infections in those six cities (assuming that 10% of the adult population received linked testing) up to 17.2% (assuming that 90% of the adult population received linked testing).
To minimize interaction with health care staff, a self-administered oral swab could test for HIV, the researchers noted. They added that while fingerstick HIV testing would require more interaction, it could also allow for screening of hepatitis C and other viruses, as well.
The modeling study was intended to assess not only the efficacy of linked testing, but also the cost. Although the price tag was significant (up-front costs alone ranged from $21 million at the 10% linked-testing level to $221 million at the 90% level), the authors argued that the short-term investment would be offset by long-term savings in health care costs due to fewer people living with HIV.
Beyond cost, potential roadblocks to implementation of a linked-testing approach included insufficient lab capacity to process both tests, insufficient staff for HIV testing, and the possibility of fewer people volunteering to be tested for SARS-CoV-2 if they knew that HIV testing would also be offered. On the other hand, “Incorporating HIV testing and linkage to care within SARS-CoV-2 viral and serological testing, when done responsibly and with input from the most affected communities, could be a promising approach to addressing these overlapping racial/ethnic health disparities in the United States,” the study authors wrote.