STIs and Usage of PrEP During the COVID-19 Pandemic

Rates of Sexually Transmitted Infections (STIs) and engagement in HIV pre-exposure prophylaxis during the COVID-19 pandemic were previously unknown, but one IDWeek study examined these data trends over the past few years.

At a virtual presentation during IDWeek, one team explored whether the COVID-19 pandemic in 2020 affected rates of sexually transmitted infections (STIs) and commencement of HIV pre-exposure prophylaxis (PrEP), as presented by Omar Harfouch, clinical fellow and a lead author of the study.

From the Veterans Affair Maryland Health Care System (VAMHCS), investigators gathered patient data on demographics, STI testing (chlamydia, gonorrhea, syphilis), and International Classification of Diseases (ICD) diagnosis codes and refills of TDF-FTC and TAF-FTC.

To evaluate how the pandemic affected these variables, they compared the 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. Individuals with a positive HIV test were excluded from the study. Patients already on PrEP were identified through pharmacy refill data, which defined their initiation of care. Using chi-square tests, the investigators compared differences in PrEP initiation between years and patient demographics.

The results showed there was a significant increase in STI positivity rate, from 44.2% in 2018 and 42.9% in 2019 to 61.6% in 2020. Researchers partially attributed this uptick to testing fewer people in 2020; 2434 STI tests were conducted in 2020, as compared to 3754 in 2018 and 3750 in 2019.

As for PrEP, 17% of eligible patients refilled PrEP in 2020, as 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 refilled PrEP appeared to decrease with time, from 44 years in 2018 to 43 years in 2019, and finally 41 years in 2020.

Another trend that emerged in the results was a statistically significant disparity in race and PrEP refill rate. In 2020, only 11.7% of Black patients refilled PrEP, while 26.2% of white patients and 23.3% of patients of other races refilled PrEP.