Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2022 Aug 24;75(1):e1020-e1027. doi: 10.1093/cid/ciac038.
Uptake of HIV pre-exposure prophylaxis (PrEP) has been increasing in the United States since its FDA approval in 2012; however, the COVID-19 pandemic may have affected this trend. Our objective was to assess the impact of COVID-19 on PrEP prescriptions in the United States.
We analyzed data from a national pharmacy database from January 2017 through March 2021 to fit an interrupted time-series model that predicted PrEP prescriptions and new PrEP users had the pandemic not occurred. Observed PrEP prescriptions and new users were compared with those predicted by the model. Main outcomes were weekly numbers of PrEP prescriptions and new PrEP users based on a previously developed algorithm. The impact of the COVID-19 pandemic was quantified by computing rate ratios and percentage decreases between the observed and predicted counts during 15/3/2020-31/3/2021.
In the absence of the pandemic, our model predicted that there would have been 1 058 162 PrEP prescriptions during 15/3/2020-31/3/2021. We observed 825 239 PrEP prescriptions, a 22.0% reduction (95% CI: 19.1-24.8%) after the emergency declaration. The model predicted 167 720 new PrEP users during the same period; we observed 125 793 new PrEP users, a 25.0% reduction (95% CI: 20.9-28.9%). The COVID-19 impact was greater among younger persons and those with commercial insurance. The impact of the pandemic varied markedly across states.
The COVID-19 pandemic disrupted an increasing trend in PrEP prescriptions in the United States, highlighting the need for innovative interventions to maintain access to HIV-prevention services during similar emergencies.
自 2012 年 FDA 批准以来，美国的 HIV 暴露前预防 (PrEP) 使用率一直在上升；然而，COVID-19 大流行可能影响了这一趋势。我们的目的是评估 COVID-19 对美国 PrEP 处方的影响。
我们分析了 2017 年 1 月至 2021 年 3 月期间来自全国一家药店数据库的数据，以拟合一个中断时间序列模型，预测如果没有发生大流行，PrEP 处方和新 PrEP 用户的情况。观察到的 PrEP 处方和新用户与模型预测进行了比较。主要结局是根据之前开发的算法，每周 PrEP 处方和新 PrEP 用户的数量。通过计算观察到的和预测到的计数之间的比率和百分比下降来量化 COVID-19 大流行的影响，时间范围为 2020 年 3 月 15 日至 2021 年 3 月 31 日。
在没有大流行的情况下，我们的模型预测在 2020 年 3 月 15 日至 2021 年 3 月 31 日期间，将有 1058162 例 PrEP 处方。我们观察到 825239 例 PrEP 处方，减少了 22.0%（95%CI：19.1-24.8%），这是在紧急声明后发生的。模型预测同期将有 167720 名新 PrEP 用户；我们观察到 125793 名新 PrEP 用户，减少了 25.0%（95%CI：20.9-28.9%）。大流行对年轻人群和商业保险人群的影响更大。大流行的影响在各州之间差异显著。
COVID-19 大流行扰乱了美国 PrEP 处方的上升趋势，这凸显了在类似紧急情况下需要创新干预措施来维持获得 HIV 预防服务的机会。
