Patterns of HIV Pre-exposure Prophylaxis Use Before and During the COVID-19 Era in the Bronx, NY

Abstract

<h3>Context:</h3> HIV pre-exposure prophylaxis (PrEP) is an antiretroviral medication recommended to individuals at high risk to prevent HIV acquisition. Disruptions in clinical care due to COVID-19 may have impacted access to and use of PrEP services. <h3>Objective:</h3> To compare trends in continuity of PrEP use and related care before and during the COVID-19 era in the Bronx, a high HIV prevalence area severely impacted by COVID-19. <h3>Study Design and Analysis:</h3> We analyzed data from a clinical cohort of patients prescribed PrEP from January 2019 to June 2021 to understand temporal trends (before versus during the COVID-19 pandemic) in PrEP use and related HIV and sexually transmitted infection (STI) testing. <h3>Dataset:</h3> The Einstein-Rockefeller-CUNY Center for AIDS Research (ERC-CFAR) Clinical Cohort Database contains electronic health records (EHR) on patients living with HIV and confirmed HIV-negative patients in the Montefiore Health System, the largest HIV care provider in the Bronx, NY. The Bronx has the highest rate of new HIV diagnoses in New York City. <h3>Population Studied:</h3> 1,318 patients were prescribed PrEP during the period (75% cisgender men, 22% cisgender women, 3% transgender women; 49% Hispanic, 29% non-Hispanic Black; median age 34 years). <h3>Intervention:</h3> PrEP prescription, HIV/STI testing. <h3>Outcome Measures:</h3> PrEP continuation (proportion of PrEP users prescribed PrEP in the previous quarter with prescription for refill); quality of care (proportion of PrEP users prescribed PrEP in the previous quarter who received HIV, gonorrhea, chlamydia, and/or syphilis testing); number of newly prescribed PrEP users per quarter. <h3>Results:</h3> There was no change in continuation of PrEP use, with an average of 64% from the previous quarter obtaining a refill throughout the time period. There was a significant drop in HIV/STI testing at the beginning of the COVID-19 pandemic, which rebounded to pre-pandemic levels by the end of 2020. There was also a large drop in new PrEP users at the beginning of the COVID-19 pandemic, which has slowly increased since, but has not reached pre-pandemic levels. <h3>Conclusions:</h3> COVID-19 resulted in fewer new PrEP prescriptions and disruption of clinic-based HIV/STI testing among PrEP users, but without a corresponding decrease in PrEP continuation among established users. Early implementation of telemedicine and home-based testing likely helped to maintain care standards despite pandemic-related challenges and should be expanded to ensure PrEP access.