Evaluation of the impact of human immunodeficiency virus pre-exposure prophylaxis on new human immunodeficiency virus diagnoses during the COVID-19 pandemic.

AIMS: The national PrEP programme launched in Ireland in November 2019 with tenofovir/emtricitabine free to those meeting eligibility criteria. We assessed the impact of the first year of the PrEP programme on new HIV diagnoses in the largest sexual health and HIV service in Ireland. METHODS: A free PrEP service was established in November 2019. We reviewed the number of new diagnoses of HIV between November 2018-2019, before the introduction of the national PrEP programme and compared this with the number of new HIV diagnosis between November 2019-2020. RESULTS: There were 95 new HIV diagnoses (63.3% MSM) between November 2018 and 2019 and 73 new HIV diagnoses (65.7% MSM) between November 2019 and 2020. There was a statistically significant decline in new HIV diagnoses between the 2 years (P = 0.0003). 546 patients were prescribed PrEP as of December 2020.106 patients (19.4%) changed their PrEP dosing regimen due to lockdown. 178 individuals (32.6%) had a rectal infection diagnosed. CONCLUSION: There has been a reduction in new HIV diagnoses in our cohort (although this has occurred during a global pandemic). It is too early to say if PrEP reduces late presentations of HIV based on our findings. A significant number of rectal infections were identified in the PrEP clinic suggesting ongoing risk despite pandemic restrictions. Further research into sexual practices during COVID-19 is needed to assess if this had an impact on the lower rates of HIV acquisition.

Changing practices in a large urban HIV clinic in response to COVID-19

Background/Purpose In March 2020 the World Health Organisation declared Covid-19 a global pandemic. Ireland responded by shutting all non-essential shops, businesses and schools. Our healthcare system had to adapt and rapid adaptations were made to ambulatory HIV care. Approach Records were virtually reviewed and triaged using existing electronic patient records(EPR) prior to appointments. Antiretrovirals(ARVs) were pre-prescribed and prepared by pharmacy for those anticipated to remain on the same ARVs. We determined those for whom routine phlebotomy could be diverted. We paused cervical, STI screening and vaccination programme in the initial phase, reopening in a more streamlined manner as the pandemic went out of each wave and adapting again as it went back into a new wave. We undertook a staff survey to assess their views on the new service delivery. Outcomes/Impact We conducted a survey of our staff members across all disciplines. There were 34 responses out of 53 staff members. 76.47% agreed that pre reviewing EPR was better for patient care, 88.24% believed that patient flow was improved, 76.47% believed that patients time in the department was reduced due to the virtual reviews and that covid- 19 risk was reduced. 80% of doctors felt that doing the virtual reviews was a valuable training experience. 50% believed that there was more time available to deal with complex cases. Innovation and Significance Pre prescribing medications has led to better patient flow and social distancing during clinic. Complex issues, in many cases can be addressed prior to clinic and discussed with senior providers. Stricter adherence to appointment times is more convenient for patients and staff. This system has allowed us to identify patients with complex medical needs and presented opportunity for education and training between senior and junior providers, whilst decreasing Covid-19 risk to provider and patient..