Scientific Papers

Site assessment survey to assess the impact of the COVID-19 pandemic on HIV clinic site services and strategies for mitigation in Washington, DC | BMC Health Services Research

Table 1 shows descriptive characteristics of the DC Cohort clinics by clinic type, size, number of providers, and COVID testing and vaccine support. All 14 DC Cohort clinic principal investigators responded to the survey. Fifty percent of the clinics were community-based, 50% were hospital-based, and the majority were Ryan White funded clinics (64%).

Table 1 Descriptive characteristics of DC cohort HIV clinical sites, Pre and Peri-pandemic (N = 14 Clinics)

Only two clinics reported closing temporarily during the pandemic (Table 1). One clinic reported being closed for four months, in which only telehealth, prescription filling and mailing, drawing labs, and urgent care services were offered to patients, and the other reported that their two locations closed at different periods of time during 2020 for approximately 3 months each, with consolidation of services at the other site and through telehealth. Seventy-nine percent of clinics offered COVID-19 testing, the majority of which were PCR (n = 11) and 50% rapid antigen tests (n = 7), most providing results within two to three days (n = 7). Most clinics provided COVID-19 vaccinations at their clinics (n = 11). Two clinics reported referring patients to a specific location for vaccinations, and two reported notifying all patients about where vaccinations were locally offered (data not shown).

Nearly 63% of clinics reported providers using telehealth prior to the pandemic and had been utilizing telehealth for less than one year pre-pandemic (Table 1). When assessing the frequency of providers offering telehealth at each clinic, the majority (n = 11) reported that less than ten percent of providers at the clinic utilized telehealth prior to the pandemic, and most (n = 10) experienced an increase in the prevalence of providers utilizing telehealth during the pandemic (data not shown). All 14 clinics reported having labs drawn on site pre-pandemic and the majority (n = 12) reported continuing this service (data not shown). However, one clinic provider detailed that during the first wave of the pandemic, labs were performed at commercial labs, although the in-house labs were never completely closed as the clinic is a part of a larger hospital organization.

Table 2 presents the frequency counts and percentages of clinic service modifications and strategies for identifying and supporting those lost to follow-up at the clinic sites. Several strategies were adopted throughout the pandemic with respect to ARV access and organizational changes. With respect to ARV access, most clinics adopted multi-month dispensation of ARV medication (n = 11) and alternative drug delivery via postal/courier service, home/community delivery, or pick-up (n = 11). Regarding appointment strategies, most clinics used staff working at home to contact patients remotely to encourage appointment attendance (n = 9). Organizational strategies reported by clinics included reduced clinic hours (n = 5). Strategies for identifying and supporting those lost to follow-up during the pandemic included offering care to persons with any income level and insurance status (n = 9), using e-prescribing for auto refills even if the patient missed visits (n = 8), and checking for hospitalizations of lost patients using the CRISP electronic health record system (n = 8).

Table 2 Characteristics of service modification at DC Cohort HIV clinical sites throughout the COVID-19 Pandemic (N = 14)

Figure 1 shows the percentage of clinics that reported a decrease in a particular service in pandemic Wave 1 (March 2020 to June 2020) and pandemic Wave 5 (December 2021 to April 2022) compared to the pre-pandemic era. The services most impacted by the pandemic were in-person HIV care appointments and virtual HIV care appointments. Comparing Wave 1 changes and Wave 5 changes, in-person care observed an 85.7% decrease in Wave 1 and a 21.4% decrease in Wave 5, compared to the pre-pandemic era. Additionally, in Wave 1 virtual care increased by 100%; however, in Wave 5 it was observed to have increased by 42.9%, compared to the pre-pandemic era. All other services offered experienced a decrease in Wave 1 compared to the pre-pandemic era. However, by Wave 5 all other services experienced mostly no change in service availability compared to the pre-pandemic era. Data on service changes in Waves 2, 3 and 4 were also reported (See Supplemental Figure).

Fig. 1
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DC Cohort HIV Clinic Service Changes throughout the COVID-19 Pandemic Comparing Wave 1 and Wave 5 Relative to the Pre-Pandemic Era

There was minimal impact of the pandemic on medical, social, and laboratory services offered: on-site clinical pharmacy, urgent care, job training referrals, substance abuse counseling, opioid treatment programs, nurse navigation, housing referrals, transportation services, and STI testing. Although most services offered before the pandemic continued to be steadily available, some clinics modified services including: on-site clinical pharmacy (n = 1), urgent care (n = 1), substance abuse counseling (n = 2), case management (n = 1), and peer intervention programs (n = 1). None of these services were permanently discontinued at any of the clinics. Additionally, the site that temporarily closed continued to only offer virtual care and fill/mail prescriptions, while lab draws and urgent care services remained available at the clinic’s hospital location.

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