HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic: Results from a prospective observational study in Germany

Statutory health insurance-covered pre-exposure prophylaxis in Germany: changing trends in nationwide tenofovir disoproxil/emtricitabine prescriptions during the COVID-19 pandemic

Background: In 2019, Germany introduced a law to reimburse high-incidence populations for pre-exposure prophylaxis (PrEP), prescribed as tenofovir-disoproxil/emtricitabine (TDF/FTC), via statutory health insurance (SHI). We studied changes in TDF/FTC-prescriptions after the implementation of this law and during the COVID-19 pandemic. Methods: We performed an interrupted time series analysis with monthly prescriptions per defined time period as the outcome. We considered the introduction of SHI-covered PrEP (09/2019) as an interruption, and four COVID-19 waves and two national lockdowns (2020-2021) as explanatory variables. We extrapolated prescriptions had the lockdowns not occurred, and compared this to the actual prescriptions. We performed sub-analyses based on stratification by five federal states with the highest proportion of PrEP users. We assessed the models' goodness-of-fit based on the adjusted R-squared using RStudio. Results: The best fitting model included SHI-covered PrEP and the first COVID-19 lockdown (04/2020). The decrease in prescriptions during the first lockdown was significant nationally, and in the five federal states for single-month prescriptions. The first lockdown resulted in reductions of 57.7% (95% prediction interval (PI): 23.0%-92.4%) for single-month prescriptions, while 17.4% (95% PI: 0.28%-34.5%) nationally, and 13.9% (95% PI: -3.67%-31.5%) for 3-month prescriptions. Conclusion: Introduction of SHI-covered PrEP resulted in a doubling of TDF/FTC-prescriptions nationwide in the first month alone. A drop in prescriptions was most apparent after the first lockdown, and particularly affected PrEP initiations, possibly due to reduced healthcare access and behavioural changes. Ongoing monitoring of TDF/FTC-prescriptions is needed to safeguard access to preventative care such as PrEP and particularly PrEP initiation during public health crises like COVID-19.

Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review

Drug-related harms, including harms from sexualised drug use (SDU), are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Chemsex, a type of SDU practiced mainly by MSM, is associated with methamphetamine use and increased HIV seropositivity or risk of acquisition. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. The impact of coronavirus disease 2019 (COVID-19) on chemsex is unknown. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use (and factors associated with these changes) following the onset of the COVID-19 pandemic. This report presents findings related to SDU/chemsex among MSM. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Decreased chemsex practice was associated with COVID-19-related fear. This synthesis suggests that chemsex practice continued, and for some MSM increased, throughout COVID-19 pandemic 'lockdowns'. This may have increased COVID-19 transmission and severity among potentially vulnerable MSM.

[Sexually transmitted infections under the influence of the COVID-19 pandemic]

Sexually transmitted infections (STI) in Germany are constantly rising. STI screening and testing decreased during the coronavirus disease 2019 (COVID-19) pandemic due to redistribution of public health resources. During the pandemic, there was a decline in the diagnosis of STIs. A minor aspect of this could be explained by reductions in the number of sexual contacts and therefore actual reduced infections, but the greater aspect seems to be due to underdiagnosis. A dramatic surge of infections is expected in the next few years. It is of utmost importance to resume STI screening for early detection and treatment and thereby lowering the transmission of STIs.

Is HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men Effective in a Real-World Setting? Experience with One-On-One Counseling and Support in a Sexual Health Center in Paris, 2018-2020

HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' care engagement, which is often mediocre and poorly measured in real-world settings. This study aimed to assess the effectiveness of a PrEP program in a sexual health center that included accompanying measures to improve engagement. A retrospective observational study was conducted. All men who have sex with men (MSM) who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal sexual health center, Paris, France, were included. Among the 125 MSM who initiated PrEP, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of post-exposure prophylaxis. During the first year, patients attended a median of three visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) had a successful PrEP course, assessed by a novel metric. These results highlight the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures and one-on-one counseling by a trained counselor could explain the effectiveness of this PrEP program.

HIV infections and AIDS in Poland in 2020

PURPOSE

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2020 in comparison to the changes in preceding years.

MATERIAL AND METHODS

Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. A dataset on clients from anonymous Voluntary Testing and Counselling (VCT) network was also used. The activities of the VCT are coordinated by the National AIDS Center, which anonymously collects epidemiological and behavior data on people who come for testing.

RESULTS

In 2020 there were 934 HIV cases newly diagnosed in Poland (diagnosis rate 2.44 per 100,000), including 100 among non-Polish citizens. The number of newly detected HIV infections decreased by 39.9% compared to the previous year and was lower by 26.9% compared to the median in 2014-2018 years. Similarly, among VCT clients, number of HIV diagnoses decreased by 42%, from 536 in 2019 to 308 in 2020 year, what was connected with 44% decreased in number of HIV tests. The total number of AIDS cases was 50 (incidence 0.13 per 100,000). The HIV infection was most often detected in the age group between 30 and 39 (35.7%) and among men (83.5%). Among cases with known transmission route, 68.5% concerned among men who had sexual contact with men (MSM). The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by almost 14 percent points in comparison to 2019 (from 75.8% to 62% of all incident AIDS cases).

CONCLUSION

In 2020, the number of newly detected HIV infections decreased compared to the previous year, however, this is not only due to a decrease in the number of infections, but rather to a lack of continuity in the diagnostic and reporting system during the COVID-19 pandemic, as indicated by a smaller number of tests and greater delays in data reporting. Due to the chronic course of HIV infection, a full assessment of the impact of the COVID-19 pandemic will be possible in the future.