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Impact of the COVID-19 Pandemic on the PrEP Cascade at Two Veterans Affairs Healthcare Systems

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Abstract

Overall, fewer Veterans were eligible for PrEP in 2020, compared to 2019, and 2018 (Maryland Veterans Affairs Health Care System- MVAHCS-: n = 890 (2020), n = 1533 (2019); Washington DC Veterans Affairs Medical Center -DC VAMC- n = 1119 (2020), n = 1716 (2019)). While the proportion of Veterans engaged in PrEP out of those eligible for PrEP increased in 2020 compared to 2019 at both sites (MVAHCS: 5.73% (2020) vs. 3.39% (2019) p-value = 0.006; F = 7.58, and DC VAMC: 15.91% (2020) vs. 9.38% (2019) p-value < 0.001; F = 27.64), the absolute number of Veterans engaged in PrEP remained unchanged (MVAHCS n = 51 (2020) and n = 52 (2019); DC VAMC n = 178 (2020) and n = 161 (2019)). Engagement in PrEP was significantly lower among Black Veterans compared to White Veterans at the DC VAMC across all FY with a widening gap in 2020. Cisgender women were less likely to be engaged in PrEP compared to cisgender men at both sites and throughout all FY with a wider gender gap in 2020. There were no significant differences in retention in PrEP between FY.

Anticipated improvements in linkage, engagement, and retention in PrEP in 2020 at the MVAHCS and DC VAMC may not have been seen due to the COVID-19 pandemic. Furthermore, engagement rates in PrEP remained low overall, particularly among Black Veterans and cisgender women. Novel PrEP delivery models are needed to engage these populations in PrEP following the COVID-19 pandemic. Interactive dashboards and tele-PrEP may have played a big role in sustained retention in PrEP at the VHA.

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Acknowledgements

This material is the result of work supported with resources and the use of facilities at the U.S. Department of Veterans Affairs MVAHCS Baltimore, MD, USA and the DC VAMC.

Conflict of Interest.

The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest. The contents of this presentation do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. School of Medicine, University of Maryland, Institute of Human Virology, Baltimore, MD, USA

    Omar Harfouch & Eleanor Wilson

  2. Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA

    Emily Comstock, Roman Kaplan & Eleanor Wilson

  3. Washington DC Veterans Affairs Medical Center, Washington DC, USA

    Debra Benator & Heather Rivasplata

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  1. Omar Harfouch
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  2. Emily Comstock
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Correspondence to Omar Harfouch.

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Harfouch, O., Comstock, E., Kaplan, R. et al. Impact of the COVID-19 Pandemic on the PrEP Cascade at Two Veterans Affairs Healthcare Systems. AIDS Behav 28, 1227–1234 (2024). https://doi.org/10.1007/s10461-023-04146-5

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