Impact of the coronavirus disease 2019 pandemic on prescriptions for antiretroviral drugs for HIV treatment in the United States, 2019–2021

Abstract

Objective:To assess disruption in healthcare services for HIV treatment by national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic in the United States.Design:Time-series analysisMethods:We analyzed the IQVIA Real World Data–Longitudinal Prescriptions Database and calculated time trends in the weekly number of persons with active antiretroviral prescriptions for HIV treatment, and of persons who obtained antiretroviral prescriptions during January 2017–March 2021. We used interrupted time-series models to estimate the impact of the COVID-19 pandemic on antiretroviral therapy (ART) use between March 2020 and March 2021.Results:We found that the weekly number of persons with active antiretroviral prescriptions decreased by an average 2.5% (95% confidence interval [CI]: −3.8% to −1.1%), compared to predicted use, during March 2020 through March 2021. The weekly number of persons who obtained antiretroviral prescriptions decreased 4.5% (95% CI: −6.0% to −3.0%), compared to the predicted number. Men, persons aged ≤34 years, privately insured persons, and persons in medication assistance programs had greater decreases than other groups.Conclusions:We demonstrated a decrease in the number of persons with active antiretroviral prescriptions during the first year of the COVID-19 pandemic and the number did not return to levels expected in the absence of the pandemic. Disruptions in HIV care and decreased ART may lead to lower levels of viral suppression and immunologic control, and increased HIV transmission in the community.

Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta

“…Our overall results generally comport with three studies considering individual HIV services, especially on the much smaller impact on ART than other services, as expected given that they involve the same data sources [18][19][20]. However, our comparison of two cities allows…”

“…Our main source for PrEP and ART is the IQVIA Real World Data-Longitudinal Prescriptions Database (IQVIA). Methods for extracting prescription counts and defining continuous usage spells vs. new prescriptions have been described previously [18,20]. We consider three measures for PrEP and ART each, by week: number of ongoing prescription spells, number of spells initiated, and number terminated.…”

HIV Services and Outcomes During the COVID-19 Pandemic — United States, 2019–2021

“…Similarly, during 2020, the number of persons prescribed PrEP decreased 6% from Q1 (190,955) to Q2 (179,280) but increased to 184,320 in Q3 (2019-2021 EQPC = 3.45%). Following a similar pattern, during 2020, HIV diagnoses decreased 6% from Q1 (8,438) to Q2 (6,228) but increased to 7,905 in Q3 (2019-2020 EQPC = −3.99%). The proportion of persons linked to HIV care, the number who were prescribed ART, and the proportion with a suppressed viral load test result among those tested was stable during the study period.…”

“…As unemployment increased during the pandemic ( 2 ), many persons lost employer-sponsored health insurance ( 3 ). HIV testing and PrEP prescriptions declined early in the COVID-19 pandemic ( 4 – 6 ); however, the full impact of the pandemic on use of HIV prevention and care services and HIV outcomes is not known. To assess changes in these measures during 2019–2021, quarterly data from two large U.S. commercial laboratories, the IQVIA Real World Data — Longitudinal Prescription Database (IQVIA), † and the National HIV Surveillance System (NHSS) § were analyzed.…”

Isolating the effect of COVID-19 related disruptions on HIV diagnoses in the United States in 2020

“…The outbreak of COVID-19 in 2020 has significantly disrupted the HIV continuum of care in the United States. Recent work has shown that COVID-19-related disruptions have affected Pre-exposure prophylaxis (PrEP) uptake and adherence [1], antiretroviral therapy (ART) uptake and adherence [2], and HIV testing and care provision [3], [4]. It is therefore not surprising that HIV diagnoses in the United States decreased substantially in 2020, with official data suggesting a drop of approximately 17% from 2019 [5], [6].…”