Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020

We present preliminary results of a coronavirus disease (COVID-19) impact assessment on testing for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region. We analyse 98 responses from secondary care (n = 36), community testing sites (n = 52) and national level (n = 10). Compared to pre-COVID-19, 95% of respondents report decreased testing volumes during March–May and 58% during June–August 2020. Reasons for decreases and mitigation measures were analysed.

and number of testing sites that your response represents e. Please indicate the type of primary health care site your response represents: 4. Please provide your email address: Please note: We will use and store your email address exclusively to contact you if we need clarification regarding your survey response or to identify duplicate responses. We will not share it with any other organisation or use it for any other purpose than stated here.
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Reasons for any observed declines in HIV/HCV/HBV/STI testing volume
If you observed a decrease in testing volume for any of the infections indicated above, please provide the reasons and indicate if the impact-level was Major, Medium, Minor, Not applicable, Do not know, or No decrease.
Please also elaborate in the comment box below if the reasons differed across the different infections.
Major Medium Minor Not applicable

Do not know
No decrease Laboratory closed during lockdown Staff normally supporting HIV/HCV/HBV/STI testing was re-allocated to support COVID-19 Equipment normally used for serologic HIV/HCV/HBV/syphilis testing was re-allocated to support COVID-19 testing Equipment normally used for PCR-based HIV/HCV/HBV/STI testing was re-allocated to support COVID-19 testing Funding normally used for HIV/HCV/HBV/STI testing was reallocated to support COVID-19 Reduced opening hours etc./no open 'drop-in' times Fewer appointments scheduled/fewer referrals to your lab Fewer samples sent to your lab Stock-out of sampling tubes, reagents or consumables for HIV/HBV/HCV/STI testing Triaging of patients (stricter criteria for who is being offered testing) Other Please provide any additional comments or explanations you find relevant to explain the decrease in testing (FOR NATIONAL LEVEL RESPONDENTS ONLY) a. There were difficulties in contacting the specialist care unit(s) normally referred to b. There were delays in scheduling consultations c. No referral to specialists was possible, except for emergency situations d. No elective procedures/ investigations were possible, except emergency situations e. Specialist care unit(s) normally referred to were closed for a period of time f. People were reluctant to be linked g. Other (please specify):

Changes to national level HIV, viral hepatitis and STI testing policies and practices generated as a result of the COVID-19 pandemic
In the table below, please provide the percentage of persons testing/screening positive in your site who were linked to care in the indicated time periods Please provide your best estimate or percentage range, but enter as a percentage. If no data is available, please type in 'No data'

New measures implemented to restore testing provision in response to COVID-19
What measures were put in place to restore the provision of (diagnostic) testing services for HIV, viral hepatitis and STIs in your facility/setting in response to the COVID-19 pandemic (please check all that apply)? Expanded outreach testing k. Testing campaigns l.
Other (please specify) 1. If HIV self-testing is being offered at your facility/site, please indicate how it is implemented (please tick all that apply) a. On-site distribution of self-testing kits b. Self-testing is provided by referral but kits need to be purchased elsewhere (pharmacy, online etc.) c. We offer counselling and referral to confirmatory testing/linkage to care for people with a positive self-test result d. Do now know e. Other (please specify) Please elaborate on your response as relevant Free text field (NOT FOR NATIONAL LEVEL RESPONDENTS OR LABORATORIES)

Changes in testing or counseling performed remotely, through self-testing or home-based sampling
Please indicate what percentage of people being counselled for HIV, viral hepatitis or STI (diagnostic) testing, who were offered the following in the indicated time periods. Please provide your best estimate or percentage range, but enter as a percentage. If no data is available, please type in 'No data'

March-May 2020
June-August 2020 Percentage of clients receiving testing counselling who received it remotely (via phone or online)?
Percentage of clients receiving testing counselling who were offered or referred to HIV self-testing?
Percentage of clients receiving testing counselling who were offered home-based sampling?
Please elaborate on your response as relevant Free text field

New measures implemented to support continued provision of PrEP
If you provide follow-up for people on PrEP, did you implement any of the following changes in PrEP provision after the pandemic declaration?

COVID-19 testing
Have you considered adding COVID-19 testing to your services? a. We haven't thought about it b. We don't think it makes sense for us c. We do not think it will be possible d. Yes, we would be willing to incorporate the offer of COVID-19 rapid tests e. We are already performing COVID-19 testing f. Other (Please specify) If "Yes," what kind of tests would you be willing to incorporate (or are you already using)? a. Serological rapid tests b. Antigen rapid tests c. Both types of rapid tests d. Sample collection for PCR e. Other (Please specify) Why do you think it is not going to be possible to incorporate COVID-19 testing? (Select all that apply) a. We do not have resources to buy the tests b. We are not going to be able to get the tests c. Our service is not going to be allowed to perform d. the tests e. Only health care professionals are allowed to f. perform the tests g. Other (Please specify)

Main negative and positive consequences, service adaptations and lessons learned
In your opinion, what were the major negative consequences of the COVID-19 pandemic on your provision of HIV, viral hepatitis and STIs prevention, testing and care services?
Please describe (free text field) In your opinion, what were the main positive consequences of the COVID-19 pandemic on your provision of HIV, viral hepatitis and STIs prevention, testing and care services and will any of the positive lessons learned continue to impact how services will be provided in the future?
Please describe (free text field) (ONLY FOR NATIONAL LEVEL RESPONDENTS) In your opinion, what were the major negative consequences of the COVID-19 pandemic on your country's HIV, viral hepatitis and STIs prevention, testing and care services?
Please describe (free text field) (ONLY FOR NATIONAL LEVEL RESPONDENTS) In your opinion, what were the main positive consequences of the COVID-19 pandemic and will service adaptations/positive lessons learned continue to impact how services will be provided in the future?
Please describe (free text field) (ONLY FOR NATIONAL LEVEL RESPONDENTS)

Financial impact
Were there financial cuts in the public funding to the HIV/Hep/STI response as a result of the COVID pandemic?
a. Yes b. No c. No data available d. Do not know

Support needs going forward
Is there any specific guidance or support that you would consider important in the coming months to reduce the impact of COVID-19 on testing for HIV, viral hepatitis and STIs in your facility/setting? (select all that apply) a. Additional human resources b. Increased financial support c. Regulatory changes (please elaborate) d. Programmatic guidance (free text) e. Technical guidance (free text) f. Technical support on specific issue (free text) g. Procurement/supply chain related support (free text for details) h. Other (specify which other -free text) i. No, none Please elaborate on your response as relevant Free text field Please use this space to provide any additional comments, links to resources, etc.