Figure 1.
COVID-19 related events and changes in HIV service engagement. (A) Timeline of COVID-19-related events in British Columbia. The majority of restrictions were put in place during mid-March, 2020, culminating on March 21st. (B) Line plot showing the number of new individuals added to the dataset by year. Each line shows the number of individuals reporting a given risk factor, with the orange line delineating the total number of individuals per year, regardless of risk factor. “Both” indicates individuals who reported both MSM and PWID as possible routes of transmission. “Other” indicates either individuals with no reported risk factor information available or individuals who reported risk factors other than MSM or PWID, such as heterosexual sex, receipt of contaminated blood products or mother-to-child transmission. C) Bar plot showing the number of new individuals sequenced in each time period in each year. Pre-lockdown, lockdown, and post-lockdown represent the same 60-day time periods in each of the years, where pre-lockdown includes January 22–March 21, lockdown includes March 22–May 20 and post-lockdown includes May 21–July 19. It is important to note that since our dataset ends on June 4th 2021, the count for the post-lockdown period for 2021 is cut off here. D) Reduction in engagement with HIV prevention and management services following the implementation of lockdown restrictions coincides with increases in the amount of change to time spent in residential locations. The grey dashed line marks March 21st. Abbreviated markers of engagement include viral load (VL) tests yielding undetectable viral load, pre-exposure prophylaxis (PrEP) prescriptions, antiretroviral therapy (ART) initiations, and visits to overdose prevention services (OPS) and safe consumption sites (SCS). Change in time spent at home was assessed relative to baseline, as defined in the Google COVID-19 Mobility Reports data as the median value for a given day of the week from the five-week period between January 3, 2020 and February 6, 2020. The red line shown represents the 7-day rolling average of change in time spent at home. Data describing monthly engagement with HIV prevention and management services were collected by the BC-CfE Drug Treatment Program and the BC Centre for Disease Control (BCCDC). Data describing visits to OPS and SCS originated from the BCCDC Overdose Response Indicator Report. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)