BACKGROUND: COVID-19 has impeded healthcare in the US since March 2020. We described the impact of COVID-19 on HIV preexposure prophylaxis (PrEP) care at a Boston community health center specializing in sexual healthcare.
METHODS: We extracted electronic healthcare data for patients with at least one active PrEP prescription during January-April 2020. We described trends in PrEP initiations and refill lapses (i.e., lack of refill before end of prior prescription), testing for gonorrhea/chlamydia (GC/CT) and HIV, and telehealth. We assessed covariates associated with refill lapses in April 2020 using chi-squared tests.
RESULTS: Of 3520 PrEP patients, the mean (SD) age was 36.9 (11.2), 72.7% were white, 13.6% Latinx, 92.1% cisgender men and 12.9% publically insured. From January to April, PrEP initiations decreased by 72.1% (122/month to 34/month), refill lapses increased by 278% (140/month to 407/month), and the number of PrEP patients decreased by 17.9% (Figure 1). GC/CT and HIV tests each decreased by 85.1% (1058/month to 158/month for GC/CT and 1014/month to 151/month for HIV), while GC/CT test positivity rates increased slightly (12.3% to 15.8%; Figure 2); the only HIV diagnosis among PrEP patients was in January. Clinical encounters decreased by 26.3% (1419 to 1046) and transitioned from 0% to 97.7% telehealth. Refill lapses were associated with being 'ยค26y (p=0.001), non-white (p=0.001), Latinx (p=0.049), and publically insured (p=0.002).

CONCLUSIONS: COVID-19 was associated with disruptions in PrEP care, especially among vulnerable subpopulations, despite high use of telehealth. Studies to understand whether changes in PrEP care reflect decreased sexual risk or barriers to optimal healthcare are needed.