Washington, DC—Adherence to pre-exposure prophylaxis (PrEP) for HIV dropped significantly during shelter-in-place orders (SIPOs) for COVID-19, according to a new survey.

Data from the online survey was presented recently at the International AIDS Conference (AIDS 2020: Virtual) by the American Academy of HIV Medicine. It revealed that a third of respondents had stopped their using their prophylactic medications and 85% of those advised that they did so because they were not engaging in risky behaviors.

The online survey, conducted with Gilead Sciences HIV Medical Affairs, sought to understand how SIPOs impacted PrEP access, use, and HIV-risk behaviors among current PrEP users. Of the 409 PrEP users surveyed, only 11 responded that an outside factor affected their ability to obtain PrEP (lost job/insurance, could not complete laboratory monitoring or HIV and STI testing, or provider was unable to refill).

In terms of sexual behaviors during the SIPOs, more than half of the respondents reported zero sexual events and zero sexual partners.  Furthermore, 89% stated that they have decreased the number of sex partners, 90% reported a decrease in the number of sex events, and 88% reduced the frequency of using online applications to meet partners.

Only 8% of those users who discontinued PrEP cited inability to access their medications. Nearly all prescribers, 95%, were able to successfully prescribe PrEP despite limitations caused by SIPOs.

When the physician specialty group questioned 188 PrEP providers about provision of care, it was told by 47% that some of their patients had elected to stop PrEP during the SIPO, which was much higher than the self-reported numbers from the patient cohort. On the other hand, 89% of providers said they did not recommend that patients change their PrEP routines during shelter-in-place.

Providers who completed the survey reported the following changes to their care delivery:
• 68% implemented telemedicine practices; 
• 59% indicated refilling PrEP medications while postponing routine HIV/sexually transmitted infection (STI) and laboratory tests, to be completed as soon as possible; and 
• 15% opted to completely forgo testing and laboratory monitoring. 

Of the 20% of responding providers who encountered PrEP users with suspected STIs for which they could not obtain a test, 47% said they treated STIs empirically.

Despite the closures and reduced hours of health facilities, the CDC issued a “dear colleague” letter in May 2020 stating that reducing the number of new HIV infections remains a public health priority and offering detailed guidance on providing HIV-1 PrEP when facility-based services and in-person patient-clinician contact is limited.  

“Reducing the number of new HIV transmissions and ensuring access to critical HIV prevention services must remain a public health priority during this challenging time,” explained Bruce Packett, executive director, The American Academy of HIV Medicine. “These data demonstrate the crucial role that technology-enabled care can play in helping facilitate the safe and timely delivery of critical public health services. My hope is that clinics and HIV prevention providers can continue to adapt to changing circumstances by offering expanded use of telehealth services and other innovative tools to help meet the evolving needs of people at risk for HIV.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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