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.
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.
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).
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.