Characterizing the impact of the COVID-19 pandemic on HIV testing among Medicaid beneficiaries

Objectives: Estimate the HIV testing, diagnoses, and test positivity rates among Medicaid beneficiaries in 2016-2021 and assess the impact of the COVID-19 pandemic on these outcomes. Design: Prospective observational study of Medicaid enrollment, inpatient, and outpatient claims data from 27 states, 2016-2021. Methods: We assessed Medicaid claims from adult beneficiaries with full benefits whose first continuous enrollment was ≥6 months without dual enrollment in other insurance, and without previous HIV diagnosis. We estimated the rates of annual testing, HIV diagnosis, and proportion of positive HIV tests among the tested using Poisson regression models. Bayesian structural time series modelling was performed to examine the pandemic's impact on study outcomes with 3/16/2020-12/31/2021 as the pandemic period. We estimated rates overall and by age, sex, race/ethnicity, and states' level of COVID-19-related restriction policies. Results: We included 20,508,785 beneficiaries. Male beneficiaries, especially 18-34-year-olds, had lower annual testing uptake and higher test positivity rates than female beneficiaries. Black beneficiaries had higher annual testing rates than White and Hispanic beneficiaries. While the pandemic acutely disrupted the increasing pre-pandemic testing trend, the rates recovered to the expected level had the pandemic not happened, except among 18-34-year-old male beneficiaries, whose pandemic rates were, on average, 18.1% lower (95% confidence interval:-22.3,-13.8) than projected rates. HIV diagnosis and test positivity rates were not affected by the pandemic. Conclusion: The pandemic significantly impacted the testing uptake among young male beneficiaries, highlighting the need for innovative strategies to improve HIV testing uptake in this demographic, restoring it to pre-pandemic levels or better.