Evaluating the Use of HIV PrEP Within the Military Health System During the COVID-19 Pandemic

Introduction: Adequate provision and equitable utilization of HIV preexposure prophylaxis (PrEP) is crucial to reducing HIV incidence. Nearly all new HIV infections among active duty services members occur among males; Black men are disproportionately affected (>40% of new infections). We investigated the effect of the Coronavirus disease-19 (COVID-19) pandemic on oral PrEP use among beneficiaries of the Military Health System. Materials and Methods: We analyzed demographic and PrEP prescription data from approximately 4.5 million TRICARE Prime beneficiaries aged 18-64 years during the pre-COVID-19 (October 1, 2016-February 28, 2020) and COVID-19 periods (March 1, 2020-September 30, 2022). We compared the characteristics of beneficiaries that initiated PrEP during the pre-COVID to COVID-19 periods. Results: Overall, 89,761 PrEP prescriptions were issued among 15,658 enrollees out of which 56,779 prescriptions (18.7% of which were new prescriptions) were issued in the pre-COVID-19 period while 32,982 prescriptions (10.8% of which were new prescriptions) were issued during the COVID-19 period. Black beneficiaries represented 20% of PrEP initiations. Percentage of beneficiaries who initiated PrEP (0.25% vs 0.10%) (P < .001) and reductions in PrEP initiation were noted across all demographic stratifications for race, rank, and sex (P < .001). Overall, beneficiaries were 65% less likely to initiate PrEP during the COVID-19 period after adjusting for covariates (adjusted odds ratio (aOR) 0.35; CI 0.33-0.38), potentially because of changes in access, behaviors, or perceived risk. In addition, the cumulative length of PrEP prescriptions (210 days vs 90) (P < .001) declined from pre-pandemic to pandemic period. Conclusion: Continual efforts to identify those at greatest risk for acquiring HIV, including men who have sex with men, are needed to ensure adequate provision of PrEP to those at greatest risk.