Postpandemic Trends and Missed Opportunities in Prevention and Diagnosis of Pediatric HIV

Abstract

Background: Progress against HIV in the US slowed during the COVID-19 pandemic. Associated impacts for pediatric HIV may be substantial amid pandemic-related exacerbations of health inequities. We assessed pre-/post-pandemic trends in pediatric HIV diagnoses and characterized gaps in prevention or diagnosis. Methods: We performed a retrospective cohort study of children and adolescents with HIV (CAHIV) <18 years of age, treated at Indiana University Health facilities from January 2009 to December 2023. Demographic data, acquisition route, risk factor(s) and diagnosis year were abstracted, and compared pre-/post-2020. To assess trends, an interrupted time series analysis was conducted using an autoregressive integrated moving average model. Postpandemic missed opportunities for prevention or diagnosis were categorized. Results: Among 126 CAHIV, with perinatal (73%) or nonperinatal (27%) HIV, 104 were diagnosed pre-2020 and 22 were diagnosed 2020 onwards. HIV diagnosis post-2020 was associated with nonperinatal acquisition ( P < 0.001), older age ( P = 0.004), US birth ( P = 0.002) and US diagnosis ( P < 0.001). Nonperinatal diagnoses in 2022 (n = 6) and 2023 (n = 5) were significantly higher than 1.6/year prepandemic (95% prediction interval 0-3.6). Among 8 CAHIV with perinatal HIV diagnosed post-2020-4 US-born-missed opportunities occurred across the mother-infant/pediatric care cascades. Among 14 CAHIV with nonperinatal HIV diagnosed post-2020, there were missed opportunities for preexposure prophylaxis (79%) and for HIV testing (65%) despite documented risk factors and indications. Conclusions and relevance: Nonperinatal HIV diagnoses increased post-2020, with gaps in adolescent prevention and diagnosis. Perinatal diagnoses in US-born infants signal critical gaps in perinatal prevention. Dedicated efforts are needed to prevent new pediatric HIV in the US.