Table 1.

Multilevel challenges and responses to supporting PLWH during the COVID-19 pandemic, based on the socio-ecological model framework

Individual	Interpersonal	Organizational	Community	Public Policy
• High COVID-19 risk perception • Pre-existing mental health conditions exacerbated • Decreased medication compliance and lack of recent lab results • Employment instability • Return to care with increased free-time due to unemployment	• Isolation from fellow PLWH • Resentment towards service providers due to in-person service restrictions	• Preparedness from experience with previous HIV outbreaks • New intakes and face-to-face interactions severely limited • Virtual intakes and follow-ups • Geographical and technological contact limitations with clients • Tablets for telehealth • No-contact home visits and at-will pickup for supplies and medications • Rental assistance • Initial decrease in HIV testing • Implemented self-swab testing, outdoor testing, and physical barriers	• Local private sector financial and material assistance • Collaboration with jails and treatment centers for HIV test kits and virtual instruction and education	• In-person requirement for quarterly review suspended • Laptop restrictions for work-related activity suspended • Sufficient CARES Act funding for clients • Lack of funding for operating expenses