The Impact of COVID-19 on Racial and Ethnic Disparities in HIV Pre-Exposure Prophylaxis Retention: Data from a Large U.S. Health Care Organization

Adam C. Sukhija-Cohen (), Michael F. Blasingame, Henna Patani, Marie C. D. Stoner, Antón Castellanos-Usigli and Allysha C. Maragh-Bass
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Adam C. Sukhija-Cohen: Center for Health Systems Research, Sutter Health, 795 El Camino Real, Ames Building, Palo Alto, CA 94301, USA
Michael F. Blasingame: Healthvana, 7162 Beverly Boulevard, Suite 238, Los Angeles, CA 90036, USA
Henna Patani: AIDS Healthcare Foundation, 6255 West Sunset Boulevard, 21st Floor, Los Angeles, CA 90028, USA
Marie C. D. Stoner: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
Antón Castellanos-Usigli: AIDS Healthcare Foundation, 6255 West Sunset Boulevard, 21st Floor, Los Angeles, CA 90028, USA
Allysha C. Maragh-Bass: Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC 27710, USA

IJERPH, 2025, vol. 22, issue 11, 1-7

Abstract: Retention in pre-exposure prophylaxis (PrEP) care—defined as receiving a fourth PrEP prescription within 12 months of initiation—remains a major challenge for young adults and individuals minoritized by race and ethnicity in the United States (U.S.), particularly after disruptions in care from the Coronavirus Disease 2019 (COVID-19) pandemic. This study examined changes in PrEP retention before and after COVID-19 among clients ages 18–29 years at AIDS Healthcare Foundation (AHF) Wellness Center clinics across the U.S. We conducted a retrospective analysis of electronic health record (EHR) data from 6047 clients who initiated PrEP between 1 January 2018 and 15 March 2023. Retention was defined as receiving a fourth PrEP prescription within 12 months of initiation. Overall, PrEP initiation increased threefold post-COVID-19, but retention by the fourth prescription declined from 86.2% pre-COVID-19 to 62.6% post-COVID-19 ( p < 0.001). Clients initiating PrEP post-COVID-19 had significantly lower odds of retention (odds ratio [OR] = 0.13; p < 0.001), suggesting these systemic disruptions reduced continuity of care. Additionally, clients who identify as non-White had lower retention odds compared to clients who identify as White post-COVID-19 (OR = 0.80; p = 0.003), indicating that racial/ethnic disparities in PrEP care persist beyond the pandemic’s impact. These findings highlight the need for targeted interventions to strengthen retention in PrEP care post-COVID-19.

Keywords: HIV; pre-exposure prophylaxis; retention in care; racial disparities; ethnic disparities (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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