HIV Care Linkage and Initial Viral Suppression Among Persons Newly Diagnosed With HIV in North Carolina Before and After the Start of the COVID-19 Pandemic.

Objectives. To examine changes to HIV care outcomes during the COVID-19 pandemic. Methods. We used North Carolina HIV surveillance data between 2018 and 2022 to calculate cumulative incidence differences (CIDs) and subdistribution hazard ratios (sdHRs) for (1) 30-day initial HIV care linkage, (2) 150-day stable linkage, and (3) 180-day viral suppression, comparing persons diagnosed with HIV during (starting March 1, 2020) versus before the pandemic. We defined a notable decrease as CID of -0.05 or less or an sdHR of 0.95 or less. Results. Overall, there were no notable decreases in linkage and viral suppression during the pandemic. In subgroup analyses, Black, Hispanic, and transgender persons had higher rates of initial linkage and unchanged or lower rates of stable linkage during versus before the pandemic. Hispanic persons had progressively lower viral suppression incidence during the pandemic. Conclusions. The North Carolina HIV care system appeared robust to pandemic harms overall; however, we observed notable differences in some subpopulations and pandemic subintervals. Public Health Implications. Statewide programs will need to build on past successes while strengthening current efforts to meet national HIV goals, particularly in groups experiencing pandemic harms to care. (Am J Public Health. 2025;115(9):1480-1489. https://doi.org/10.2105/AJPH.2025.308108).