One-third of HIV PrEP users discontinued medication while sheltering in place
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A recent survey showed that approximately 33% of patients in the United States discontinued PrEP while sheltering in place during the COVID-19 pandemic.
Most patients stopped taking PrEP because they believed that they were at lower risk for acquiring HIV given the circumstances of sheltering in place, not because of an inability to access the medication, researchers found.
Jonathon Anderson, PharmD, director of HIV prevention medical affairs at Gilead Sciences, and colleagues surveyed PrEP users (n = 409) and providers (n = 189) alike starting April 21, when shelter-in-place orders (SIPOs) were in effect in cities nationwide, though May 15. The providers were part of a network of the American Academy of HIV Medicine (AAHIVM), which collaborated with Gilead on the survey.
They found that 33% of PrEP users under SIPOs discontinued the medication — 83% of whom did so voluntarily. Of those patients, 85% said they discontinued PrEP because of a perceived low HIV risk. Only a handful of patients discontinued PrEP because of an inability to access the medication.
PrEP users “overwhelmingly” reported decreased risk behaviors while in lockdown, according to Scott Brawley, director of development, policy and programs at AAHIVM. For example, 89% reported fewer sexual partners, 90% reported fewer sexual encounters and 88% reduced the use of apps and websites to find sex partners.
Among the providers who were surveyed, 95% said they were still able to prescribe PrEP during SIPOs, even though more than 90% put restrictions in place because of the pandemic, such as providing telehealth or phone consultations only and reducing working hours.
In an interview with Healio, Anderson emphasized one finding — that about 90% of providers did not recommend a change to a patient’s PrEP regimen, suggesting that there may be a discrepancy in the way PrEP providers and users perceived HIV risk during this time.
When asked about routine HIV and STI testing and lab monitoring, 3% of providers said they stopped testing, 54% decreased testing, 41% did about the same level of testing and only a small minority — 1% — increased access to testing.
Notably, one in five providers said they encountered a patient with a suspected STI that they were unable to test for, but nearly half (47%) treated a suspected STI empirically without seeing the patient or getting them tested, “erring on the side of caution,” Brawley said during a presentation.
Other findings presented at this year’s conference showed how disruptive COVID-19 has been to PrEP uptake. Researchers reported that despite the use of telehealth at a community health center in Boston, PrEP initiation fell by 72% between January and April, and refill lapses increased by 278%.
Providing access to HIV prevention services “remains critical,” Anderson said.
“Despite limited facility-based services or in-person patient-clinician contact due to these shelter-in-place orders, nearly all of the health care providers [in the survey] were able to continue prescribing PrEP to individuals at risk for HIV. Providers should continue to adapt both during shelter-in-place orders and look forward to adapting after shelter-in-place orders as we understand the impact that COVID-19 has on the future of health care.”
Bruce J. Packett, executive director of AAHIVM, agreed with Anderson, saying in a press release that providers should “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.”
References:
- Brawley S, et al. Impact of COVID-19-related shelter-in-place orders on PrEP access, usage and HIV risk behaviors in the United States. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
- Krakower D, et al. Impact of COVID-19 on HIV pre-exposure prophylaxis care at a Boston community health center. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
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Brawley S, et al. Impact of COVID-19-related shelter-in-place orders on PrEP access, usage and HIV risk behaviors in the United States. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
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