Miller Sarah J, Kaur Amandeep, Yang Xueying
Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA.
Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA.
J Racial Ethn Health Disparities. 2025 Apr 17. doi: 10.1007/s40615-025-02429-2.
The COVID-19 pandemic created numerous barriers to pre-exposure prophylaxis (PrEP) access in the United States (US). The present study aimed to understand changes in county-level PrEP use relative to the need for PrEP during the COVID-19 pandemic, particularly for racial minorities.
Public county-level data from 2019 to 2022 were used. Linear mixed models with multiple imputations and adjusting for covariates were used to examine changes in PrEP rate and PrEP to need ratio (PNR) across time. We also assessed PNR and PrEP rate across time allowing for race and time interactions. Finally, we examined PNR and PrEP rate among age groups over time.
There was no difference in PrEP prevalence between 2019 and 2020 (p > 0.05). However, compared to 2019, PrEP prevalence was higher in 2021 and 2022 (p < .05). There was no change in PNR in 2020 or 2021 from 2019 (p > 0.05). Compared with 2019, PNR increased in 2022 (p < 0.05). Non-Hispanic Black population concentration did not predict the PrEP rate in 2020 or 2021 (p > 0.05), though it did predict a slight increase in PrEP prevalence in 2022 relative to 2019 (p < 0.05). Concentration non-Hispanic Black population did not predict PNR in any year (p > 0.05).
Although PrEP use began increasing from pre-pandemic levels by 2021, PNR increases did not occur until 2022. Increases in PNR did not occur in areas with greater concentrations non-Hispanic Black individuals, suggesting disparities worsened during the pandemic. Addressing racial disparities is key in responding to COVID-19 related disruptions to HIV prevention efforts.
2019冠状病毒病（COVID-19）大流行给美国的暴露前预防（PrEP）带来了诸多障碍。本研究旨在了解COVID-19大流行期间县级PrEP使用相对于PrEP需求的变化，特别是针对少数族裔。
使用了2019年至2022年的县级公共数据。采用多重填补和调整协变量的线性混合模型来研究PrEP使用率和PrEP需求比（PNR）随时间的变化。我们还评估了考虑种族和时间交互作用时PNR和PrEP使用率随时间的变化。最后，我们研究了不同年龄组随时间的PNR和PrEP使用率。
2019年和2020年的PrEP流行率没有差异（p>0.05）。然而，与2019年相比，2021年和2022年的PrEP流行率更高（p<0.05）。2020年或2021年的PNR与2019年相比没有变化（p>0.05）。与2019年相比，2022年的PNR有所增加（p<0.05）。非西班牙裔黑人人口集中度在2020年或2021年并未预测PrEP使用率（p>0.05），不过相对于2019年，它确实预测了2022年PrEP流行率略有上升（p<0.05）。非西班牙裔黑人人口集中度在任何一年都未预测PNR（p>0.05）。
尽管PrEP的使用从大流行前的水平开始在2021年有所增加，但PNR直到2022年才增加。在非西班牙裔黑人个体集中度较高的地区，PNR并未增加，这表明在大流行期间差距有所恶化。解决种族差异是应对与COVID-19相关的艾滋病毒预防工作中断的关键。
