COVID-19-related PrEP disruptions offer lessons for future public health crises, international review indicates

Authors of a meta-analysis about pre-exposure prophylaxis (PrEP) services during the height of the COVID-19 pandemic recommended several measures for mitigating interruptions during future public health crises. These included telehealth consultations, multi-months prescriptions, home delivery, integration of pre-exposure prophylaxis into other services, and financial help.

About This Study

“A systematic review and meta-analysis of the impact of the COVID-19 pandemic on access to HIV pre-exposure prophylaxis: lessons for future public health crises” was published online on July 12, 2024, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Luh Putu Lila Wulandari, Ph.D., of The Kirby Institute at the University of New South Wales in Sydney, Australia, and of the Faculty of Medicine at Universitas Udayana in Bali, Indonesia.

Key Research Findings

This meta-analysis of 13 studies with a total of 12,652 participants already using PrEP explored the impact of the COVID-19 pandemic on access to PrEP services. Data were collected around 2020, for one to nine months, in 19 countries around the world. Countries were categorized as high income (most), as well as low and middle-income.

Overall, 21% of participants reported disruptions in access, with such reports ranging from 3% to 56% of participants in individual studies. In five studies that included an analysis of PrEP discontinuation, reasons for stopping included less sexual activity and fewer sexual partners.

Cost was a major reason for the disruptions as closed clinics required people to travel farther to access testing and prescription services. This issue was exacerbated by a loss of income such as with sex workers. While HIV testing rates dropped, sexually transmitted infection rates rose during the pandemic, indicating that HIV testing was still needed. Health care systems also struggled to deliver HIV prevention services while also handling COVID-19 prevention and treatment.

Discussion Highlights and Implications for Practice

The researchers reported that this analysis was limited by heterogeneous study designs, most studies conducted in high-income countries, an unclear relationship between reported disruptions and local lockdown periods, and changing needs for HIV prevention services as COVID-19 prevention measures impacted sexual activity.

Study authors recommended steps to assure PrEP access during future public health crises: telehealth, prescriptions for several months at a time, home delivery of medications, local peer support groups, and financial support. Integrating PrEP into other care–e.g., by providing it at syringe service sites–could also alleviate some of the workload issues experienced by health care professionals during a similar crisis.

By Barbara Jungwirth