Department of Internal Medicine, Health and Hospitals/Bellevue, 462 First Avenue, New York, NY, 10016, USA.
Department of Population Health, New York University Langone Health, New York, NY, USA.
AIDS Behav. 2023 Aug;27(8):2507-2512. doi: 10.1007/s10461-023-03977-6. Epub 2023 Jan 7.
To understand the impact of COVID-19-related disruptions on PrEP services, we reviewed PrEP prescriptions at NYC Health + Hospitals/Bellevue from July 2019 through July 2021. PrEP prescriptions were examined as PrEP person-equivalents (PrEP PE) in order to account for the variable time of refill duration (i.e., 1-3 months). To assess "PrEP coverage", we calculated PrEP medication possession ratios (MPR) while patients were under study observation. Pre-clinic closure, mean PrEP PE = 244.2 (IQR 189.2, 287.5; median = 252.5) were observed. Across levels of clinic closures, mean PrEP PE = 247.3, (IQR 215.5, 265.4; median = 219.9) during 100% clinic closure, 255.4 (IQR 224, 284.3; median = 249.0) during 80% closure, and 274.6 (IQR 273.0, 281.0; median = 277.2) during 50% closure were observed. Among patients continuously prescribed PrEP pre-COVID-19, the mean MPR mean declined from 83% (IQR 72-100%; median = 100%) to 63% (IQR 35-97%; median = 66%) after the onset of COVID-19. For patients newly initiated on PrEP after the onset of COVID-19, the mean MPR was 73% (IQR 41-100%; median = 100%). Our ability to sustain PrEP provisions, as measured by both PrEP PE and MPR, can likely be attributed to our pre-COVID-19 system for PrEP delivery, which emphasizes navigation, same-day initiation, and primary care integration. In the era of COVID-19 as well as future unforeseen healthcare disruptions, PrEP programs must be robust and flexible in order to sustain PrEP delivery.
为了了解与 COVID-19 相关的中断对 PrEP 服务的影响，我们审查了 2019 年 7 月至 2021 年 7 月期间纽约市健康与贝尔维尤医院的 PrEP 处方。PrEP 处方以 PrEP 人当量 (PrEP PE) 进行检查，以考虑到不同的 refill 持续时间（即 1-3 个月）。为了评估“PrEP 覆盖率”，我们在患者接受研究观察时计算了 PrEP 药物持有率 (MPR)。在诊所关闭之前，平均 PrEP PE 为 244.2（IQR 189.2，287.5；中位数 252.5）。在诊所关闭的各个层面上，在 100%诊所关闭期间，平均 PrEP PE 为 247.3（IQR 215.5，265.4；中位数 219.9），在 80%关闭期间为 255.4（IQR 224，284.3；中位数 249.0），在 50%关闭期间为 274.6（IQR 273.0，281.0；中位数 277.2）。在持续开处方 PrEP 的患者中，在 COVID-19 发病前，平均 MPR 从 83%（IQR 72-100%；中位数 100%）下降到 63%（IQR 35-97%；中位数 66%）。对于在 COVID-19 发病后开始接受 PrEP 的患者，平均 MPR 为 73%（IQR 41-100%；中位数 100%）。我们通过 PrEP PE 和 MPR 衡量的维持 PrEP 供应的能力可能归因于我们在 COVID-19 之前的 PrEP 交付系统，该系统强调导航、当天启动和初级保健整合。在 COVID-19 时代以及未来不可预见的医疗保健中断时期，PrEP 计划必须强大且灵活，才能维持 PrEP 的提供。
