Table 4 Qualitative Themes and Illustrative Quotations

1. Disruptions due to COVID-19

1.a. Reduction in staff availability and morale

Q1: “We were open. We never closed. We were hit very hard. We had almost 70% of our staff tested positive…Our regular time, the phone doesn’t stop, doesn’t stop. Imagine when we had 70% workin’ out. Imagine. We had used every single person for everything. The doctor was the medical assistant, was a doctor, was the phlebotomist. Imagine, he did everything.” (Test Counselor 1)

1.b. Disruptions to organizational networks

Q2: “We were not able to always get in contact with certain organizations because of COVID, that's like at the first couple of months, the way people were doing things changed significantly.” (Test Counselor 2)

1.c. Challenges transitioning to telehealth

Q3: “As far as everything else, it’s all been virtual, and that’s been really hard. It’s really hard to gauge anything with a client virtually. That’s the biggest barrier.” (Test Counselor 3)

1.d. Reduction in outreach and available services

Q4: “We're not able to provide the testings that we used to do. We used to go to different locations to provide testing, but because of the pandemic, we're really limited to what we're able to do.” (Test Counselor 4)

1.e. Reduction in client access and demand for services

Q5: “What has impacted us is people—we used to get more people to come in to be tested, but because of the fear of people being infected or more susceptible to be impacted by COVID, some people are very limited, and they don't—we don't have that many people coming to our center, only via appointments. It's getting a little better, but at the beginning…it was really difficult.” (Test Counselor 4)

2. Resilient innovations in the context of COVID-19

2.a. Increased availability of telehealth to address healthcare needs during and beyond COVID-19

Q6: We're going to try, yes there's definitely patients who do, who did enjoy the lab box or did enjoy like the telehealth services and getting access to their [online medical] chart and things like that, so we have tried to keep that implementation, and then we also still offer it as an option so we're definitely trying to kind of broaden our horizons, in that way. (Test Counselor 5)

2.b. Increased availability of other remote service options

Q7: A client goes online, whether it be through an ad or a website and basically there’s a section there where they go click to sign up. They fill out some information first name, last name, phone number, email address a few other demographics there. They submit and then within 24 to 40 hours someone calls them by phone to do the pre-test questionnaire, a demographic questionnaire, and the risk factor questionnaires that would typically be done in the office. Then they get an at home HIV testing self-kit. If they live nearby the office they can actually pass by and drop it off. Or they can also test in their car if they don’t mind driving to the location, that’s option one. Option two which is the most popular is that the counselor themselves actually goes to the residence and drops it off at their home. Obviously, you know no contact, so they stay in their car or they just drop it off the porch or something like that they do that. Or the third option, which it really depends on distance, would be mailing it to them using the…HIV self-testing website as a way to have it delivered.” (Test Counselor 6)

2.c. Flexible methods of community-based outreach and engagement

Q8: “We go into the chat room [using social media or dating apps like Grindr], not necessarily chat rooms, but we make a profile, we talk to them about why we’re here, we’re sex educators, let’s talk about sex, keeping safe, PrEP, all that stuff. Well, I don’t necessarily say it was entirely up to COVID. I mean they were kind of headed in that direction. COVID just pushed it along.” (Test Counselor 7)

2.d. Organizational adaptations to facilities and workspaces

Q9: “We've had to kind of revamp the way we do testing in general…in regards to wearing PPE, maintaining social distancing, pre-screening clients when they come into our agency, with temperature checks and things like that.” (Test Counselor 8)

3. Emerging and ongoing health disparities in the context of COVID-19

3.a. Increase in HIV disparities attributable to COVID-19

Q10: “Because they [Hispanic population] still need to learn more about PrEP. In my experience of providing testing, especially when it comes to somebody who is from the Hispanic population and background they have no idea that this PrEP is available. If it was like this before the pandemic, now it’s even worse, because they’re not going to be tested.” (Test Counselor 9)