Sustaining PrEP Prescriptions at a Safety-Net Hospital in New York City During COVID-19: Lessons Learned

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Healthcare Management

Background:

• COVID-19 significantly disrupted healthcare services, including the provision of pre-exposure prophylaxis (PrEP) for HIV prevention.
• Understanding the impact of these disruptions on PrEP services is critical for maintaining HIV prevention efforts.
• NYC Health+Hospitals/Bellevue's PrEP program data from July 2019 to July 2021 was analyzed to assess service continuity.

Approach:

• PrEP prescriptions were quantified as PrEP person-equivalents (PrEP PE) to standardize for variable refill durations (1-3 months).
• PrEP coverage was assessed using medication possession ratios (MPR) for patients under study observation.
• Data was analyzed across different levels of clinic closures (100%, 80%, 50%) to evaluate service impact.

Key Points:

• Despite clinic closures, mean PrEP PE remained relatively stable, indicating sustained service provision.
• A notable decline in mean MPR was observed among continuously prescribed PrEP patients post-COVID-19 onset (83% to 63%).
• Newly initiated PrEP patients achieved a mean MPR of 73% after the onset of COVID-19.

Conclusions:

• The existing PrEP delivery system, characterized by navigation, same-day initiation, and primary care integration, was key to sustaining PrEP provisions during COVID-19.
• PrEP programs require robust and flexible structures to ensure continuity of care amidst unforeseen healthcare disruptions.
• Maintaining high PrEP coverage is essential for ongoing HIV prevention strategies, especially in the context of public health emergencies.