STIs and PrEP use during the COVID-19 pandemic
In a virtual presentation during IDWeek, a team explored whether the COVID-19 pandemic in 2020 affected rates of sexually transmitted infections (STIs) and the onset of HIV pre-exposure prophylaxis (PrEP), such as presented by Omar Harfouch, clinical researcher and author of the study.
From the Veterans Affair Maryland Health Care System (VAMHCS), investigators collected patient data on demographics, STI tests (chlamydia, gonorrhea, syphilis) and International Classification of Diseases diagnostic codes ( CIM) and TDF-FTC and TAF-FTC top-ups.
To assess how the pandemic affected these variables, they compared positive STI tests in 2020 to 2019 and 2018 using chi-square tests.
Patients eligible for PrEP were identified by a positive STI test or an ICD diagnosis of high-risk sexual behavior or gender identity disorder. People who tested positive for HIV were excluded from the study. Patients already on PrEP were identified using renewal data from pharmacies, which defined their start of treatment. Using chi-square tests, the researchers compared the differences in PrEP initiation between years and patient demographics.
The results showed that there was a significant increase in the rate of STI positivity, from 44.2% in 2018 and 42.9% in 2019 to 61.6% in 2020. The researchers partially attributed this increase to testing fewer people in 2020; 2,434 STI tests were performed in 2020, compared to 3,754 in 2018 and 3,750 in 2019.
As for PrEP, 17% of eligible patients renewed PrEP in 2020, compared to 11.6% in 2018 and 14% in 2019.
The median age of patients with a positive STI test was 44 years in 2020 and 2019, and 50 years in 2018. The median age of patients who renewed PrEP appeared to decrease over time, from 44 years in 2018 at 43 in 2019, and finally 41 in 2020.
Another trend that emerged in the results was a statistically significant disparity in race and PrEP turnover rate. In 2020, only 11.7% of black patients renewed PrEP, while 26.2% of white patients and 23.3% of patients of other races renewed PrEP.