Delivering HIV Care and Prevention in the COVID Era: A National Survey of Ryan White Providers

The COVID-19 pandemic has posed significant challenges for health systems and access to care in the United States, including for people with HIV and the systems that serve them. To better understand pandemic’s impact on HIV, we surveyed the nation’s directly funded Ryan White providers. Ryan White, the federal HIV safety net program, serves over half of those in the country diagnosed with the disease, providing outpatient HIV care and support services. Our key findings are as follows:

• Respondents described an immediate pivot to new ways of providing HIV care and prevention during the early months of the pandemic.
  • Nearly all are now offering telehealth services (99%), up from 22% in the past, and are conducting about half of patient visits virtually, on average. However, the “digital divide” means telehealth services are not an option for all patients.
  • Most (89%) are offering multi-month prescriptions for antiretrovirals (ARVs), and half reported that this practice has increased due to COVID-19.
  • Seven in ten (70%) are conducting onsite COVID-19 testing.
• Nearly one-third (30%) reported an increase in new clients and nearly 40% of respondents saw a change in payer mix, primarily an increase in clients who were uninsured, followed by private coverage losses, and then increases in clients with Medicaid.
• Respondents report that clients face significant stress and uncertainty amidst the pandemic, noting declines in mental health, job loss, and decreased access to support services, among other challenges.
• Respondents also experienced significant challenges related to staffing. More than one-quarter (27%) reported staff layoffs or furloughs and the same share reduced staff hours. Moreover, staff morale was a challenge reported by three-quarters (74%) of respondents.
• Operating challenges were common, including for the 28% who shut down all or most of their HIV prevention services in response to the pandemic. Other challenges included difficulty connecting with service partners and increased costs.
• Following COVID-era public health guidelines remains a challenge for some who experience inadequate clinical space for social distancing (32%), insufficient access to COVID-19 testing (22%)and insufficient PPE (10%).
• However, despite these historic challenges, respondents largely report adjusting to a “new normal” and significant resiliency in adapting to new ways of providing care.