Table 2.

Studies evaluating viral suppression in PLWH during the COVID-19 pandemic

Authors, Publication Date	Timeframe	Design/Methods	Outcomes	Conclusions
Spinelli MA, 2022[27]	24 months before SIP vs. 13 months after SIP	Mixed-effects logistic regression followed by ITS analysis comparing before and after SIP Multi-component strategies employed during SIP (proactive outreach, expansion of housing programs, etc.) 1,816 PLWH receiving care at HIV clinic in San Francisco, California	Rate of VS: adjusted OR 1.34 (95%, CI 1.21–1.46)	The VS rate increased following the institution of the multicomponent strategies during SIP. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing programs, will be needed to support VS among underserved populations during the COVID-19 pandemic
Giacomelli A, 2021[28]	1/1/2016—2/20/2020 (before) vs. 2/21/2020—12/31/2020 (COVID-19 period)	Quasi-experimental, ITS analysis 70,349 viral load determinations during study period (patient overlap since comparing years) HIV outpatient clinic in Milan, Italy	HIV VL of < 50 copies/mL increased from 88.4% (2016) to 93.2% (2020) Significant trend toward decrease in VL ≥ 50 copies/mL before pandemic (p < 0.001), and this did not significantly change after pandemic began (p = 0.811)	A high prevalence of viral suppression was maintained among the PLWH, despite the structural barriers raised by the COVID-19 pandemic, potentially due to simplified methods of delivering care (teleconsultations and multiple antiretroviral treatment prescriptions)
Hickey MD, 2021[29]	10/17/2019—3/16/2020 (pre-SIP) vs. 3/17/2020—8/16/2020 (post-SIP)	ITS analysis comparing care engagement (clinic visits per month), VS, and retention-in-care before and after SIP 85 patients receiving care at Ward 86 (large HIV clinic in San Francisco, California)	VS: OR 1.19 (95% CI, 0.78–1.82) Proportion of patients with visits each month: OR 0.66 (95% CI, 0.39–1.11)	Care engagement and VS did not decrease in the five months following implementation of SIP; however, in-person HIV care for homeless individuals may be important for maintaining HIV outcomes during COVID-19
Spinelli MA, 2020[30]	12/1/2019—2/29/2020 (pre-SIP) vs. 4/1/2020—4/30/2020 (post-SIP)	ITS analysis comparing retention-in-care and VS before and after SIP Ward 86 (large HIV clinic in San Francisco, California); 16% of patients included homeless	Viral non-suppression: aOR 1.31 (95% CI, 1.08–1.53) Viral non-suppression in homeless individuals during pandemic: aOR 3.36 (95% CI, 2.74–4.12)	The odds of viral non-suppression were higher post-SIP, in spite of stable retention-in-care and visit volume, with disproportionate impact on homeless individuals
Calza L, 2020[31]	3/1/2020—4/15/2020	Observational, prospective study of 14 adult PLWH (all on stable ART, 13/14 with HIV RNA < 50 copies/mL) with SARS-CoV-2 co-infection Bologna, Italy	Median changes (IQR) in CD4 + T-lymphocyte count: p = 0.149 IQR in CD8 + T-lymphocyte count: p = 0.469 IQR in CD4/CD8 ratio: p = 0.818 Patients with plasma HIV RNA < 50 copies/mL were 13 (93%), so no patients had virological failure	COVID-19 did not produce a significant effect on immunological status and plasma HIV viral load after a median follow-up of 8 weeks in 14 PLWH on stable ART

Abbreviations: aOR = adjusted odds ratio; ART = antiretroviral therapy; CI = confidence interval; HIV = human immunodeficiency virus; IQR = interquartile range; ITS = interrupted time series; OR = odds ratio; PLWH = people living with HIV; SIP = shelter-in-place; VL = viral load; VS = viral suppression