Linked HIV and SAR-CoV-2 testing could substantially reduce HIV incidence and indirect health care costs, according to data published in Clinical Infectious Diseases. Investigators used a previously calibrated dynamic HIV transmission module and constructed 3 scenarios for each of the 6 cities included in the study.

Investigators estimated that the best-case hypothetical scenario of 50% reductions in sexual and drug injection risk behaviors and no disruptions in health service due to COVID-19 could result in 6733 fewer HIV infections in Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle between 2020 and 2025. These reductions could result in a 16.5% decrease in cumulative incidence, and relative reductions from 14.3% in Los Angeles to 20.4% in Miami.

In the worst-case scenario where there are no behavioral changes and 50% reductions to health services, investigators estimated 3669 additional infections across the 6 cities. Reductions in health services could result in a 9.0% increase in cumulative incidence, and relative increases ranged from 7.0% in Miami to 15.7% in New York City. No behavioral change and a 25% reduction in health services can lead to relative increases in infections in all cities, ranging from 3.4% in Atlanta to 7.5% in New York City, said investigators.

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Linked, opt-out HIV testing alongside SARS-CoV-2 testing and contact tracing was estimated to reduce HIV infections in all 6 cities. If 10% of patients were offered HIV testing and 6.6% accepted a test, there may be 576-696 (1.6-1.7%) fewer infections. If 90% of patients were offered HIV testing and 59.3% accepted, there may be 5840-7225 (16.3%-17.2%) fewer infections.

If 10% of patients were offered linked testing in Seattle, adjusted life years (QALYs) was estimated to be raised by 136-157 years. If 90% of patients were offered an HIV test in Los Angeles, QALYs was estimated to be raised by 9154-11,513 years. Costs for these services ranged from $1.4 million to $14.9 million in Seattle to $6.7 million to $71.0 million in Los Angeles. Linked testing would likely be cost saving over a 20-year period, investigators noted.

Study limitations include use of a model, unknown impact of COVID-19 on patients with HIV, and the cost-effectiveness analysis did not consider additional costs associated with implementing linked testing, such as training.

Investigators conclude that if the pandemic impacts HIV health services, infections will likely rise. However, “implementing linked HIV testing alongside SARS-CoV-2 testing has the potential to reduce the number of HIV infections by up to 17% over 5 years if 90% are offered the HIV tests [and 59.3% accept it]”, investigators concluded. They estimated that while the strategy would require incremental upfront investments of $20.6 million to $220.7 million, it would be cost-saving long term in all cities.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Zang X, Krebs E, Chen S, et al. The potential epidemiological impact of COVID-19 on the HIV/AIDS epidemic and the cost-effectiveness of linked, opt-out HIV testing: a modeling study in six US cities. Clin Infect Dis. Published online October 12, 2020. doi: 10.1093/cid/ciaa1547.