BACKGROUND: In 2020, USA implemented shelter-in-place orders (SIPOs) during the COVID-19 outbreak. These orders led to reduced staff and hours or completely closed healthcare facilities. We sought to understand how SIPOs impacted PrEP access, use, and HIV risk behaviors among PrEP users or modified PrEP providers'' practice to understand how SIPOs may impact the future of PrEP delivery.
METHODS: Electronic convenience sample surveys of PrEP users and prescribers were simultaneously deployed across a 25-day period at the height of SIPO implementation. PrEP user survey link was sent via social media and PrEP advocates. The provider survey link was emailed to more than 2500 providers from the Academy's database. Summary analysis of cohort groups for insights and trends
RESULTS: 409 PrEP users under SIPOs responded, approximately 33% reported discontinuing PrEP. Many discontinued users (83%) stopped voluntarily and of those, 85% due to low perceived HIV risk, with only 11 participants citing inability to access PrEP medications. Post-SIPO HIV risk varied among respondents (Figure 1.) Of 189 prescribers, 95% reported being able to prescribe PrEP during SIPOs despite >90% reporting practice-site restrictions. While some PrEP users discontinued PrEP, among providers: 90% recommended no PrEP regimen changes to patients; 68% implemented telemedicine practices; and 59% indicated refilling PrEP medications while postponing routine HIV/STI and laboratory tests to be completed as soon as possible; 15% opted to completely forgo testing and lab monitoring. One in five providers encountered PrEP users with suspected STIs for which they could not obtain a test and half (47%) elected to treat empirically.
Figure 1:

CONCLUSIONS: During USA SIPOs, PrEP users were able to access PrEP via telemedicine while some discontinued due to perceived low HIV risk and self-reported reduced risk behaviors. Despite in-person visits being limited, providers were able to prescribe PrEP, however, PrEP users had limited access to HIV/STI testing.