ABSTRACT
Background: In March 2020, British Columbia (BC) declared a COVID-19-related public health emergency. Measures to limit SARS-CoV-2 transmission impacted social behaviors and disrupted healthcare access. We examined client engagement in BC's province-wide, publicly-funded HIV PrEP program before and during the COVID-19 pandemic. Methods: Using de-identified data from BC's provincial PrEP Program, we describe client engagement in the 15 months pre-(Jan 2019-Mar 2020) and during (Apr 2020-Jun 2021) the pandemic, summarized by 3-month periods. Fisher's exact, Wilcoxon rank sum test, and GEE models were used to compare median number of PrEP clients (total and new) and the proportion with PrEP dispensing and HIV testing in pre-vs during pandemic periods. We also compared these outcomes in the Apr-Jun quarter of 2019 (pre-) vs 2020 (early) and 2021 (late) pandemic. Results: A total of 7300 clients engaged with the PrEP program during the 30-month study period, with median (Q1-Q3) age 33 (27-42) years, 98% cis-male, 1% trans-female, 98% gay-bisexual-MSM (gbMSM). The median (Q1-Q3) quarterly active PrEP clients increased from 4366 (4019-4677) pre-pandemic to 4754 (4683-4784) during-pandemic (p<0.001) following program expansion late 2019, but the median (Q1-Q3) number of new clients declined from 545 (504-566) to 319 (318-320;p=0.033) and the proportion of clients with HIV testing fell from 87% (87-88%) to 82% (77-82%;p<0.001). PrEP engagement in relation to the pandemic timeline (Figure) showed a transient, early pandemic drop in new initiations and medication dispensing followed by rebound. As a proportion of all active clients, new PrEP clients in the Apr-Jun quarter dropped from 14% in 2019 to 4% in 2020 (p<0.001) and remained lower at 8% in 2021 (p<0.001). A transient decrease in the proportion of new enrolees from sexual health clinics was also observed: 54% in 2019 to 44% in 2020 (p=0.017) with rebound to 55% in 2021 (p=0.784). Similarly, clients with PrEP dispensed in this quarter fell from 75% in 2019 to 56% in 2020 (p<0.001) with partial rebound to 68% in 2021 (p<0.001). HIV testing in PrEP clients fell from 87% in 2019 to 82% in 2020 (p<0.001) and remained lower at 84% in 2021 (p<0.001). Conclusion: BC PrEP program engagement declined early in the COVID-19 pandemic, with partial rebound coinciding with the easing of public health restrictions. Ongoing clinical monitoring for PrEP remains key. Continued evaluation will facilitate understanding the pandemic impact on HIV prevention programming.
ABSTRACT
Background: The novel SARS-CoV-2 pandemic first appeared in Canada in January 2020. Since November 22 2020, nearly 29,000 people in the province of British Columbia (BC) have been infected. New diagnoses have hit all-time daily highs in November, yet understanding the impact on those at risk of or living with HIV remains limited. Utilizing a population-based registry, we conducted an observational analysis of SARS-CoV-2 testing, positive cases, and outcomes among individuals receiving either HIV pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) in BC. Methods: In BC, ART and PrEP are provided at no cost to medically eligible patients through the BC Centre for Excellence in HIV/AIDS Drug Treatment Program (DTP). The DTP registry includes adults aged 18 years and older who have been prescribed publicly funded ART since 1992 or PrEP since 2018. Since the start of 2020, data from the laboratory program and DTP registry has included daily counts for SARS-CoV-2 tests performed, antibody (Ab) and RNA test results, and mortality outcomes. In this analysis, we examine demographic characteristics of DTP patients who underwent testing and COVID-19 positive cases of from March 1 to November 22 2020. Results: There were 48 (3.5%) patients diagnosed with COVID-19 among a cohort of 1,348 patients living with HIV on ART who were tested for the virus. In the PrEP cohort, there were 59 (4.5%) patients who were diagnosed with COVID-19 among the 1,304 PrEP patients tested for the virus at least once for COVID-19. There was no statistically significant (p=0.20) difference between the proportion of positive cases in ART vs PrEP group (chi-squared test). Of the 107 DTP patients who tested positive for COVID-19, the median age was 40 years (51.5 for DTP patients;32 years for PrEP patients), 97 (90.7%) were male, and 83 (77.6%) resided in the largely urban Vancouver Coastal Health Authority region. Importantly, COVID-19 positive cases among patients on ART (vs PrEP) and female patients (vs male) were more likely to be diagnosed in the second wave of the pandemic in BC (from September 2020 onwards). Promisingly, no deaths were reported among the sample as of November 22, 2020. Conclusion: We observed similar proportions of COVID-19 positive tests among PrEP and ART patients tested in our provincial registry. Growing numbers of COVID-19 positive cases among patients in ART group during the pandemic's second wave is of significant concern for ongoing community transmission outbreaks.