LAUSR

BACKGROUND The COVID-19 pandemic has disrupted HIV and sexually transmitted infection (STI) testing accessibility. We sought to assess the longer-term impacts of COVID-19 on HIV and STI testing and diagnosis in Oregon. METHODS First, we examined HIV, Neisseria gonorrhoeae (NG)/Chlamydia trachomatis (CT), and syphilis tests conducted at the Oregon State Public Health Laboratory (public sector) and a large commercial laboratory (private sector) and HIV, NG, CT, and primary and secondary (P&S) syphilis diagnoses in Oregon from 1/1/2019-12/31/2021. We compared monthly testing and diagnosis rates in five pre-specified time periods: pre-COVID-19 (1/2019-2/2020), stay-at-home order (3/2020-5/2020), reopening (6/2020-12/2020), vaccine availability (1/2021-6/2021), and Delta/early Omicron spread (7/2021-12/2021). Second, we calculated the number of HIV and STI diagnoses per test in the public and private sectors. Finally, we used seasonal autoregressive integrated moving average (SARIMA) models to predict expected HIV and STI diagnoses for comparison to those observed. RESULTS Both public and private sector HIV and bacterial STI testing fell to nadirs in April 2020 with incomplete recovery to 2019 levels by the close of 2021. Compared to pre-COVID-19, public sector and private sector testing was significantly lower in all subsequent time periods. Compared to pre-COVID-19, P&S syphilis cases were 52%, 75%, and 124% greater in the reopening, vaccine availability, and Delta/early Omicron periods, respectively. From 3/2020-12/2021, we observed an excess of P&S syphilis cases (+37.1%; 95%CI: 22.2%, 52.1%) and a deficit in CT cases (-10.7%; 95%CI: -15.4%, -6.0%). CONCLUSIONS By 12/2021, HIV/STI testing had not recovered to pre-COVID-19 levels and HIV/STI continue to be underdiagnosed. Despite decreased testing, P&S syphilis cases have increased substantially.