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The Impact of COVID-19 on Racial and Ethnic Disparities in HIV Pre-Exposure Prophylaxis Retention: Data from a Large

Adam C Sukhija-Cohen1, Michael F Blasingame2, Henna Patani3

  • 1Center for Health Systems Research, Sutter Health, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA.

International Journal of Environmental Research and Public Health
|November 27, 2025
PubMed

Insights

Pre-exposure prophylaxis (PrEP) retention declined significantly for young adults after COVID-19. Non-White individuals experienced lower retention rates, highlighting persistent racial/ethnic disparities in HIV prevention care.

Area of Science:

  • Public Health
  • Infectious Disease Epidemiology
  • Health Services Research

Background:

  • Retention in pre-exposure prophylaxis (PrEP) care is crucial for HIV prevention, especially for young adults and racial/ethnic minorities in the U.S.
  • The COVID-19 pandemic disrupted healthcare access and continuity, potentially impacting PrEP care.
  • Understanding changes in PrEP retention post-pandemic is vital for public health strategies.

Purpose of the Study:

  • To examine the impact of the COVID-19 pandemic on PrEP retention among young adults (18-29 years) in the U.S.
  • To assess changes in PrEP retention rates before and after the COVID-19 pandemic.
  • To identify disparities in PrEP retention among different racial and ethnic groups post-pandemic.

Main Methods:

  • Retrospective analysis of electronic health record (EHR) data from 6047 clients initiating PrEP.
  • Inclusion criteria: clients aged 18-29 years initiating PrEP between January 1, 2018, and March 15, 2023, at AHF Wellness Centers.
  • Retention defined as receiving a fourth PrEP prescription within 12 months of initiation; comparison of pre- and post-COVID-19 periods.

Main Results:

  • Overall PrEP initiation tripled post-COVID-19, but retention declined from 86.2% pre-COVID-19 to 62.6% post-COVID-19 (p < 0.001).
  • Clients initiating PrEP post-COVID-19 had significantly lower odds of retention (OR = 0.13; p < 0.001).
  • Non-White clients had lower retention odds compared to White clients post-COVID-19 (OR = 0.80; p = 0.003), indicating persistent racial/ethnic disparities.

Conclusions:

  • The COVID-19 pandemic significantly disrupted PrEP care continuity, leading to reduced retention among young adults.
  • Racial and ethnic disparities in PrEP retention persist and may be exacerbated by pandemic-related disruptions.
  • Targeted interventions are urgently needed to improve PrEP retention and address health inequities in HIV prevention.

Keywords:
HIVethnic disparitiespre-exposure prophylaxisracial disparitiesretention in care

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