Characterizing the Impact of COVID-19 on Pre-Exposure Prophylaxis (PrEP) Care

Rogers, Brooke G.; Tao, Jun; Maynard, Michaela; Chu, Christina; Silva, Elizabeth; Toma, Emily; Nagel, Katherine; Napoleon, Siena; Chan, Philip A.

doi:10.1007/s10461-021-03337-2

Cited by 23 publications

(25 citation statements)

References 9 publications

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“…Third, this analysis includes the time period after the start of the COVID-19 pandemic. Many clinics have identified drop-offs in PrEP clinic visits during the initial COVID-19 pandemic [ 32 ] though some have observed increases in PrEP visits [ 33 ]. Anecdotally, the clinic continued to see PrEP patients with minimal disruption during the COVID-19 pandemic; thus, we do not believe this had a major bearing on our results.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi

et al. 2022

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Pre-exposure prophylaxis (PrEP) persistence is suboptimal in the United States. In the Deep South, a region with high rates of new HIV diagnosis, patterns of PrEP discontinuation remain unexplored. We evaluated data from a clinic-based PrEP program in Jackson, Mississippi and included patients initiating PrEP between August 2018 and April 2021. We considered patients to have a gap in PrEP coverage if they had at least 30 days without an active PrEP prescription; those who restarted PrEP after 30 days were classified as ‘stopped and restarted’ and those who never obtained a new PrEP prescription were classified as ‘stopped and did not restart’. Patients without a gap in coverage were considered ‘continuously on PrEP’. We estimated median time to first PrEP discontinuation and examined factors associated with time to first PrEP discontinuation. Of 171 patients who received an initial 90-day PrEP prescription; 75% were assigned male at birth and 74% identified as Black. The median time to first discontinuation was 90 days (95% CI 90–114). Twenty-two percent were continuously on PrEP, 28% stopped and restarted (median time off PrEP = 102 days), and 50% stopped and did not restart. Associations with early PrEP stoppage were notable for patients assigned sex female vs male (adjusted hazard ratio [aHR] = 1.6, 95% CI 1.0–2.5) and those living over 25 miles from clinic vs. 0–10 miles (aHR 1.89, 95% CI 1.2–3.0). Most patients never refilled an initial PrEP prescription though many patients re-started PrEP. Interventions to improve persistence and facilitate re-starts are needed.

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Section: Discussionmentioning

confidence: 99%

Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi

et al. 2022

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“…However, the impact of the pandemic has varied greatly depending on the setting and geographic location. [49][50][51] In addition, racial and socioeconomic disparities in both COVID-19 and HIV testing, infection, and outcomes have been documented. [52][53][54] Demographic characteristics were self-reported and, in the case of race and ethnicity, could be left blank, limiting our ability to observe whether individuals of Hispanic decent were adequately provided PrEP.…”

Section: Discussionmentioning

confidence: 99%

Are We Hitting the Target? HIV Pre-Exposure Prophylaxis from 2012 to 2020 in the OPERA Cohort

Mounzer

Fusco²,

Hsu

et al. 2021

AIDS Patient Care and STDs

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Preventing HIV transmission is a crucial step in ending the HIV epidemic. Safe and effective pre-exposure prophylaxis (PrEP) has been available in the United States since 2012. We set out to determine if persons at greatest risk for HIV acquisition were receiving HIV PrEP. HIV-negative individuals from the Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort who were prescribed daily PrEP were contrasted with newly diagnosed HIV persons without PrEP use between July 16, 2012 and October 31, 2020 to determine if the PrEP prescriptions reached the populations who were seroconverting. Poisson regression was used to estimate incidence rates of seroconversion to HIV among PrEP initiators, as well as new diagnoses of sexually transmitted infections among both the PrEP group and the newly HIV+ group. Out of the 14,598 PrEP users and 3558 persons newly diagnosed with HIV in OPERA, demographics varied widely. Older individuals, those of nonblack race, men, nonintravenous (IV) drug users, and those with commercial insurance were proportionally overrepresented among those prescribed PrEP compared to persons newly diagnosed with HIV during the same time period. Over 82% of new HIV+ individuals received care in the southern United States compared to only 45% of PrEP users. Seroconversion to HIV among PrEP users was generally uncommon, although more frequent among those who identified as black individuals, especially in the 13-25 years old age range. In conclusion, providers need innovative programs to better identify, educate, and link those at greatest risk of HIV acquisition, especially young people, women, black individuals, and IV drug users, to PrEP.

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“…However, prior experiences with the HIV epidemic were instrumental in responding and ensuring communities continue to access HIV prevention services [ 18 , 19 ]. Numerous studies reported substantially reduced access and utilization of pre-exposure prophylaxis (PrEP), initial PrEP intake visits, and increases in refill lapses during the COVID-19 pandemic [ 20 , 21 ]. Many US cities also reported significant decreases in HIV testing rates – San Francisco, for example, reporting a 40% decrease citywide and a 90% decrease in community-based testing [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

From crisis to crisis: impacts of the COVID-19 pandemic on people living with HIV and HIV/AIDS service organizations in Indiana

MacNeill

Linnes

Hubach

et al. 2022

BMC Health Serv Res

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Background The COVID-19 pandemic thrust people living with HIV (PLWH) and HIV/AIDS service organizations into an environment ripe with uncertainty. This study examined Indiana HIV/AIDS service provider perceptions of how COVID-19 affected the overall health and access to care of their clients, and how the organizations prepared for, adapted, and responded to the needs of PLWH during the pandemic. Methods Guided by the socioecological model, fifteen semi-structured interviews were conducted with ten different HIV/AIDS service organizations across the state of Indiana. Results Despite the profound disruptions experienced by HIV programs, HIV/AIDS service organizations responded quickly to the challenges posed by the COVID-19 pandemic through myriad innovative strategies, largely informed by prior experiences with the HIV epidemic. Conclusions The lessons provided by HIV/AIDS service organizations are invaluable to informing future pandemic response for PLWH. Service delivery innovations in response to the COVID-19 crisis may provide insights to improve HIV care continuity strategies for vulnerable populations far beyond the pandemic.

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Characterizing the Impact of COVID-19 on Pre-Exposure Prophylaxis (PrEP) Care

Cited by 23 publications

References 9 publications

Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi

Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi

Are We Hitting the Target? HIV Pre-Exposure Prophylaxis from 2012 to 2020 in the OPERA Cohort

From crisis to crisis: impacts of the COVID-19 pandemic on people living with HIV and HIV/AIDS service organizations in Indiana

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