Human Immunodeficiency Virus

Effect of COVID-19 Pandemic on HIV Pre-Exposure Prophylaxis Uptake in the US

Madison Heck, MPH, CHES
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HIV viruses infecting T-lymphocytes, computer illustration. The surface of the T-cell has a lumpy appearance with large irregular surface protrusions. Smaller spherical structures on the cell surface are HIV virus particles budding away from the cell membrane. The virus has infected the T-cell, and instructed the cell to reproduce many more viruses. This viral budding causes the T-cell to die. Depletion of the number of T-cells in the blood is the main reason for the destruction of the immune system in AIDS.
Researchers conducted a study to assess the effect of the COVID-19 pandemic on HIV pre-exposure prophylaxis (PrEP) prescriptions and new PrEP users in the US.

Within a 1-year period following the start of the COVID-19 pandemic, there was a 22% and 25% decrease in HIV pre-exposure prophylaxis (PrEP) prescriptions and new PrEP users, respectively, according to findings published in Clinical Infectious Diseases.

In this study, researchers used data captured in a national pharmacy database between January 2017 and March 2021 to perform an interrupted time-series analysis that predicted the number of new PrEP prescriptions and new PrEP users had the COVID-19 pandemic not occurred. They sought to assess the effect of the COVID-19 pandemic on PrEP uptake in the US by comparing the number of observed PreP prescriptions and new PrEP users with those predicted by the time-series analysis. The analysis included only new or renewed PrEP prescriptions written for patients aged 16 years and older, and it excluded PrEP refills and prescriptions for HIV infection, hepatitis B virus infection, and HIV post-exposure prophylaxis. The primary outcomes were weekly numbers of PrEP prescriptions and new PrEP users.

Results of the time-series analysis for the period between March 2020 and 2021 showed a 22% decrease in the number of observed vs predicted PrEP prescriptions (825,239 vs 1,058,162; rate ratio [RR], 0.78; 95% CI, 19.1-24.8). Further analysis of the same time period also showed a 25% decrease in the number of new PrEP users observed vs those predicted (125,793 vs 167,720; RR, 0.75; 95% CI, 20.9-28.9). On analysis of PrEP prescriptions by month, the researchers observed a 17.4% decrease in PrEP prescriptions for June 2020 and a greater than 25% decrease for December 2020, February 2021, and March 2021. They also noted that compared with the number of new PrEP users predicted, there was a 39.5% and 34.2% decrease in new PrEP users observed for April and May 2020, respectively.

After stratification by demographic characteristics, the researchers found that the number of predicted vs observed PrEP prescriptions and new PrEP users did not significantly differ between men vs women, or on the basis of race/ethnicity. They also noted a greater decrease in the number of new PrEP users observed among individuals aged 16 to 29 years vs those aged 50 years and older (-27.6% vs -18.5%; 95% CI, 22.6-32.2 vs 13.7-23.1, respectively). There was a 23.5%, 15%, and 12.7% decrease in observed vs predicted PrEP prescriptions among individuals with commercial insurance (95% CI, 20.7-26.3), those with public health insurance (95% CI, 11.5-18.4), and those who paid cash (95% CI, 6.8-18.3), respectively.

The researchers found that the effect of the COVID-19 on predicted vs observed PrEP prescriptions significantly differed by state, noting a 9.9% increase in Delaware (95% CI, -20.3 to -0.4) and a 84.1% decrease in South Dakota (95% CI, 77.4-88.8). In regard to the number of new PrEP users predicted vs observed, there was a 26.4% increase in Delaware (95% CI, -57.1 to -1.7) and a 61.8% decrease in South Dakota (95% CI, 44.9-73.4). Of note, the number of observed PrEP prescriptions and new PrEP users decreased by 35% or more in California, Georgia, Illinois, Massachusetts, and New York, all of which had incurred the greatest number of PrEP prescriptions prior to the COVID-19 pandemic.

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This study was limited by the exclusion of data on PrEP prescriptions from health maintenance organizations and the inability to control for decreases in PrEP prescriptions that may have occurred due to lack of access to care or decreased risk behavior during the COVID-19 pandemic. Other limitations include that data on race/ethnicity were available for fewer than 40% of individuals prescribed PrEP.

According to the researchers, “ongoing monitoring of trends in PrEP prescriptions and PrEP users is needed to assess whether the impact of the COVID-19 pandemic abated after shutdown orders were lifted and as the vaccination rate among the population increased.” They also noted that “future studies are needed to understand the population-level implications of decreased PrEP use during the COVID-19 pandemic on HIV transmission.”

Reference

Huang YA, Zhu W, Wiener J, Kourtis AP, Hall IE, Hoover KW. Impact of COVID-19 on HIV preexposure prophylaxis prescriptions in the United States – a time series analysis. Clin Infect Dis. Published online January 18, 2022. doi:10.1093/cid/ciac038

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