Sustained Decreases of HIV Preexposure Prophylaxis Prescriptions for LGBTQ Populations in the Third Year of the COVID-19 Pandemic at a Boston Community Health Center

Introduction: The coronavirus disease 2019 (COVID-19) pandemic resulted in acute decreases in human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) prescribing and access to sexual health care in the US, but less is known about sustained changes as the COVID-19 pandemic continued. We explored patterns of PrEP prescribing and STI testing for lesbian, gay, bi, transgender, and queer (LGBTQ) populations from 2019–2022 at Fenway Health—one of the largest prescribers of PrEP (N=5,832) in the Northeastern US. Methods: After the Fenway Institute was granted institutional review board (IRB) approval in 2022, quarterly numbers of (1) total PrEP prescriptions, (2) new PrEP prescriptions, and (3) patients undergoing bacterial sexually transmitted infection (STI) screening were procured from January 1, 2019, to June 30, 2022, as well as the average number of days between prescriptions per quarter. We calculated incidence rate ratios (IRRs) which compared average quarterly numbers of prescriptions from 2020–2022 to 2019 (baseline), overall and disaggregated by race, age, and insurance status. Rates of new PrEP prescriptions and STI screening were used to contextualize the observed decline in number of PrEP prescriptions. Results: By the second quarter of 2022 (Q2 2022), PrEP prescriptions remain lower than before the COVID-19 pandemic for the study population (IRR 0.70, 95% CI 0.67–0.73, p<.001). Individuals under 30 years had a larger relative decline compared to their baseline (IRR 0.58, 95% CI 0.53–0.63, p<.001) than did older patients. Uninsured individuals had larger relative declines (IRR 0.42, 95% CI 0.30–0.58, p<.001) than those enrolled in coverage. Between 2019 and Q1-2020 the monthly average number of individuals testing for at least one bacterial STI decreased by 64%; however, by Q4-2021 rates had rebounded. Discussion: Being younger than 30 years or being uninsured was more associated with decreasing rates of PrEP prescriptions than was race. Rates of new PrEP prescriptions and testing for bacterial STIs decreased immediately after the onset of the pandemic and did not recover to pre-pandemic levels, though STI testing rates rebounded to a greater extent than new or total PrEP prescriptions. Conclusions: PrEP prescriptions remain lower than pre-pandemic levels. Decreasing numbers of prescriptions may be linked to on demand PrEP use, abstinence, disengagement from care, or receipt of PrEP elsewhere. Interviews with patients are needed to optimize PrEP engagement.