Pre-exposure prophylaxis (PrEP) uptake and service delivery adaptations during the first wave of the COVID-19 pandemic in 21 PEPFAR-funded countries

Michael Kerzner; Anindya K De; Randy Yee; Ryan Keating; Gaston Djomand; Sharon Stash; Sangeeta Rana; Allison Kimmel; Robyn Eakle; Sara Klucking; Pragna Patel; PEPFAR HIV Pre-exposure Prophylaxis Collaborators

doi:10.1371/journal.pone.0266280

Pre-exposure prophylaxis (PrEP) uptake and service delivery adaptations during the first wave of the COVID-19 pandemic in 21 PEPFAR-funded countries

PLoS One. 2022 Apr 5;17(4):e0266280. doi: 10.1371/journal.pone.0266280. eCollection 2022.

Affiliations

¹ Science Unit, Center for State, Tribal, Local, and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
² Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
³ Department of International HIV Prevention and Testing, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America.
⁴ Bureau for Global Health, Office of HIV/AIDS, United States Agency for International Development, Washington, DC, United States of America.
⁵ Office of the U.S. Global AIDS Coordinator and Health Diplomacy, U.S. Department of State, Washington, DC, United States of America.

Abstract

Background: Mitigation measures for the first wave of the COVID-19 pandemic and burden on health systems created challenges for pre-exposure prophylaxis (PrEP) service delivery. We examined PrEP uptake in PEPFAR programs before and after the start of the COVID-19 pandemic.

Methods: We studied two PEPFAR program monitoring indicators, using routine Monitoring, Evaluation, Reporting (MER) indicators capturing uptake of PrEP (PrEP_NEW) and overall use of PrEP (PrEP_CURR). We also analyzed descriptive program narratives to understand successes and challenges field teams encountered after the start of the COVID-19 pandemic. To assess changes in coverage of PrEP across 21 countries, we calculated the "PrEP to need ratio" (PnR) using a published methodology. We defined the pre-COVID time period as April 1, 2019 -March 31, 2020 and the COVID time period as April 1, 2020 -March 31, 2021.

Findings: The total number of persons who initiated PrEP increased by 157% from 233,250 in the pre-COVID-19 period compared with 599,935 in the COVID-19 period. All countries, except five, noted significant increases in PrEP uptake. PrEP uptake among adolescent girls and young women (AGYW) increased by 159% from 80,452 AGYW in the pre-COVID-19 period to 208,607 AGYW in the COVID-19 period. There were 77,430 key populations (KP) initiated on PrEP in the pre-COVID-19 period and 209,114 KP initiated in the COVID-19 period (a 170% increase). The PnR increased 214% in the COVID-19 period across all PEPFAR-supported countries. Adaptations, such as multi-month dispensing (MMD) of PrEP; virtual demand creation activities; decentralized, community-based and virtual service delivery, were implemented to maintain PrEP services.

Conclusions: PEPFAR programs continued to maintain and initiate new clients on PrEP despite the challenges posed by the COVID-19 pandemic. Adaptations such as MMD of PrEP and use of technology were vital in expanding service delivery and increasing PrEP coverage.

Funding: This project has been supported by the U.S. President's Emergency Plan for AIDS Relief.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Anti-HIV Agents* / therapeutic use
COVID-19* / epidemiology
COVID-19* / prevention & control
Female
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Pandemics / prevention & control
Pre-Exposure Prophylaxis*

Substances

Anti-HIV Agents

Grants and funding

PEPFAR/PEPFAR/United States