Pre-exposure prophylaxis adherence and risks of HIV and sexually transmitted infection among adult men before vs during the COVID-19 pandemic.

IF 3.3 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2026-10-01 DOI:10.18553/jmcp.2026.32.10.1271

Ikenna F Unigwe, Chanakan Jenjai, Amie J Goodin, Wei-Hsuan Lo-Ciganic, Robert L Cook, Jennifer W Janelle, Haesuk Park

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引用次数: 0

Abstract

Background: The COVID-19 pandemic disrupted HIV prevention services, including reductions in pre-exposure prophylaxis (PrEP) prescription and HIV testing. However, evidence on the association between the pandemic with PrEP use, as well as HIV and sexually transmitted infection (STI) rates among PrEP users remained limited.

Objective: To compare patterns of PrEP adherence, HIV incidence, and STI rates among adult men newly initiating PrEP before vs during the COVID-19 pandemic.

Methods: We conducted a new-user retrospective cohort analysis of commercially insured PrEP users using the 2018-2021 MarketScan administrative claims database. Adult men aged 18-49 years in the MarketScan administrative claims database prescribed tenofovir disoproxil fumarate with emtricitabine or tenofovir alafenamide with emtricitabine for PrEP were included. Group-based trajectory modeling was used to identify PrEP adherence patterns. After balancing group demographic and clinical characteristics with inverse probability treatment weighting, time-varying Cox proportional hazards models were used to evaluate HIV risk and Poisson regression was used to assess STI rates.

Results: Of 8,683 adult men (43% aged 25 to 34 years), 5,957 initiated PrEP before the pandemic and 2,726 during the pandemic. Prepandemic adherence trajectories included nonadherence (11.8% of the cohort) and rapidly declining (20.8%), gradually declining (21.1%), and consistently high (46.3%) adherence. Pandemic adherence trajectories included early discontinuation (35.7%) and rapidly declining (19.5%), gradually declining (14.8%), and consistently high (29.9%) adherence. Initiating PrEP during the pandemic was associated with higher risk of HIV acquisition (adjusted hazard ratio = 2.20 [95% CI = 1.08-4.47]). STI rates did not differ between groups (adjusted incidence rate ratio = 1.04 [95% CI = 0.88-1.23]).

Conclusions: Individuals initiating PrEP during the pandemic were associated with reduced PrEP adherence and higher HIV incidence. Targeted strategies to maintain access and continuity of HIV prevention services during public health emergencies are needed.

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COVID-19大流行之前与期间成年男性暴露前预防依从性与艾滋病毒和性传播感染风险

背景：COVID-19大流行扰乱了艾滋病毒预防服务，包括暴露前预防（PrEP）处方和艾滋病毒检测减少。然而，关于艾滋病大流行与使用预防措施以及预防措施使用者中艾滋病毒和性传播感染率之间关系的证据仍然有限。目的：比较COVID-19大流行前和期间新开始PrEP的成年男性的PrEP依从性、HIV发病率和STI发病率的模式。方法：我们使用2018-2021年MarketScan行政索赔数据库对商业保险PrEP用户进行了新用户回顾性队列分析。在MarketScan行政声明数据库中，年龄在18-49岁的成年男性被纳入处方富马酸替诺福韦二氧吡酯与恩曲他滨或替诺福韦阿拉胺与恩曲他滨的PrEP。使用基于组的轨迹模型来确定PrEP的依从性模式。在用反概率治疗加权平衡组人口统计学和临床特征后，使用时变Cox比例风险模型评估HIV风险，使用泊松回归评估STI发生率。结果：在8,683名成年男性中（43%年龄在25至34岁之间），5,957人在大流行前启动了PrEP， 2,726人在大流行期间启动了PrEP。大流行前的依从性轨迹包括不依从性（11.8%）、快速下降（20.8%）、逐渐下降（21.1%）和持续高依从性（46.3%）。大流行依从性轨迹包括早期停药（35.7%）、快速下降（19.5%）、逐渐下降（14.8%）和持续高依从性（29.9%）。在大流行期间启动PrEP与感染艾滋病毒的高风险相关（校正风险比= 2.20 [95% CI = 1.08-4.47]）。两组间STI发生率无差异（调整后发病率比= 1.04 [95% CI = 0.88-1.23]）。结论：在大流行期间开始PrEP的个体与PrEP依从性降低和HIV感染率升高相关。需要采取有针对性的战略，在突发公共卫生事件期间保持艾滋病毒预防服务的可及性和连续性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.