The COVID-19 pandemic and HIV notification counts in a northeastern Brazilian state, 2015–2022: an ecological study

The COVID-19 pandemic disrupted all healthcare systems in Brazil, including HIV/AIDS surveillance and control. This study aimed to quantify the pandemic’s impact on HIV case notification counts in the state of Bahia, located in northeastern Brazil, from 2015 to 2022. We conducted an observational time-series analysis of HIV cases in Bahia from January 2015 to December 2022. The pre-pandemic period (2015–2019) served as the baseline to forecast expected notification trends, which were then compared to observed case numbers during the pandemic years (2020–2022). The percentage change between observed and expected values was calculated and analyzed at the state, regional, and macro-regional levels. Between 2020 and 2022, a total of 8382 new HIV cases were expected (an average of 2794 annually). A significant reduction was observed in 2020, with a 12.8% decrease (357 fewer cases than expected), followed by a 3.2% decrease in 2021 (89 fewer cases). Notifications partially recovered in 2022, showing a 2.1% increase (50 more cases than expected). The most affected health macro-regions in 2020 were the Central-Eastern macro-region with the largest negative percentage decrease in cases (-38%). The impact was heterogeneously distributed, with the Central-Eastern macro-region experiencing the sharpest decline in 2020 (-38%), the Northern macro-region in 2021 (-21%), and the Far Southern macro-region in 2022 (-29%). The Covid-19 pandemic led to a substantial and heterogeneous reduction in HIV cases across Bahia. Although a partial recovery occurred in 2022, case detection has not yet returned to pre-pandemic projected levels. These findings underscore an urgent need for bold, targeted strategic plans to actively identify and link to care people living with HIV in the affected regions.