The impact of Covid-19 on racial and ethnic disparities in HIV pre-exposure prophylaxis retention

Abstract

Retention in pre-exposure prophylaxis (PrEP) care-defined as receiving a fourth PrEP prescription within 12 months of initiation-remains a major challenge for young adults and individuals minoritized by race and ethnicity in the United States (U.S.), particularly after disruptions in care from the Coronavirus Disease 2019 (COVID-19) pandemic. This study examined changes in PrEP retention before and after COVID-19 among clients ages 18-29 years at AIDS Healthcare Foundation (AHF) Wellness Center clinics across the U.S. We conducted a retrospective analysis of electronic health record (EHR) data from 6047 clients who initiated PrEP between 1 January 2018 and 15 March 2023. Retention was defined as receiving a fourth PrEP prescription within 12 months of initiation. Overall, PrEP initiation increased threefold post-COVID-19, but retention by the fourth prescription declined from 86.2% pre-COVID-19 to 62.6% post-COVID-19 (p < 0.001). Clients initiating PrEP post-COVID-19 had significantly lower odds of retention (odds ratio [OR] = 0.13; p < 0.001), suggesting these systemic disruptions reduced continuity of care. Additionally, clients who identify as non-White had lower retention odds compared to clients who identify as White post-COVID-19 (OR = 0.80; p = 0.003), indicating that racial/ethnic disparities in PrEP care persist beyond the pandemic's impact. These findings highlight the need for targeted interventions to strengthen retention in PrEP care post-COVID-19.