Real-world utilization of F/TDF and F/TAF for HIV Pre-exposure Prophylaxis during the COVID-19 pandemic in the US, December 2019 ' June 2020

BACKGROUND: Extensive impact of the COVID-19 pandemic on healthcare delivery has been reported, including impacts on the use of daily F/TDF and F/TAF for HIV pre-exposure prophylaxis (PrEP). Using a real-world claims database, we evaluated the utilization of PrEP in the United States (US) from December 2019 to June 2020.
METHODS: HIV-1 negative individuals in the US who used F/TDF and F/TAF for PrEP between December 1, 2019 and June 31, 2020 were identified from a prescription claims database. We conducted a retrospective descriptive trend analysis.
RESULTS: Over 46,000 individuals initiated F/TAF (median age 36 years, interquartile range, [IQR] 29'48) and 29,000 initiated F/TDF for PrEP (median age 31 years, IQR 25'40) between December 2019 and June 2020. Progressive drops in PrEP initiation were observed in February, March and April 2020, coinciding with the start of COVID-19 spread in the US and the resulting restrictions (Figure 1A). The overall number of PrEP users showed only a slight decrease after March 2020, mostly attributable to the attenuated increasing trend of F/TAF users after April (Figure 1B). PrEP initiation started to increase again after April, with more new PrEP prescriptions coming from family physicians and nurse practitioners/physician assistants and less from infectious disease physicians. Decreases in new PrEP use were seen in in multiple geographic areas and across race/ethnicity groups, with decreases most pronounced in white individuals living in the Southern US states (Figure 1C).


CONCLUSIONS: This real-world analysis demonstrates how prescription claims data can be utilized to track PrEP use amidst the significant impact of the COVID-19 pandemic. Our findings suggest that COVID-19 has had a substantial impact on PrEP initiations, while having a lesser impact on overall use. These findings suggest that targeted efforts will be needed to provide PrEP to new users during and after the pandemic.