How Different Phases of the Pandemic Influenced Behavior, HIV Testing, and PrEP Starts

With a clinical practice that focuses on the LGBTQIA+ community, Boston-based Fenway Health has been serving the local area for over 50 years. They have grown significantly and are today one of the biggest PrEP prescribers in the US. They have also been involved in HIV, PrEP, and transgender clinical studies.

A team of investigators from Fenway led by Kenneth H. Mayer, MD, medical research director, Fenway Health, and co-director, The Fenway Institute, looked at HIV, PREP, STI trends during 3 different times of the pandemic era including: the pre-pandemic (December 2019-end of February 2020), early-pandemic (March 2020-end of May 2020), and during the Delta surge (June 2021-end of August 2021).

From their work, Mayer and his team developed a poster, A New Abnormal: HIV, PREP, STI Trends During The COVID-19 Pandemic in a Boston Health Center, that is being presented at the Annual Conference on Retroviruses and Opportunistic Infections (CROI).

In terms of the results, Mayer says they saw a dramatic drop in HIV tests during the early pandemic, but that the testing numbers were trending upward by the time the Delta surge took place. He says less people started PrEP during the pandemic, but then there was an increase during Delta. He also notes that they saw a trend of people who stopped PrEP during the early stages of the pandemic but were restarting PrEP during the Delta phase.

STI testing also dropped during the pandemic but rebounded during the Delta phase. Mayer points out that like HIV testing, STI testing has not come back completely to pre-pandemic era numbers. Another interesting trend for STIs was that the positive rate for gonorrhea and chlamydia increased dramatically during the early pandemic phase. Mayer said that with less tests being done but a higher rate of disease, it says this population was likely symptomatic. He says the positivity rate decreased to pre-pandemic levels during the Delta surge suggesting that testing was going up and more asymptomatic people were getting screened.

“What is encouraging from the treatment side is that throughout all of this the rates of viral suppression stayed pretty high in the clinic, between 90-93% throughout the pandemic,” Mayer stated.

Although people sought out less clinical care during the early pandemic, Mayer points out the pandemic did lead to other aspects of clinical care being affected and have led to more lasting trends.

“There are a lot of other things we didn’t look at with this poster that we know that are going on, which we hope will help in some ways,” Mayer said. “The use of telemedicine would be the most important one, where we do a lot of Tele-PrEP.” He says telemedicine appointments can help people get started on PrEP earlier.

Contagion spoke to Mayer recently about the findings from their research, and some of the effects of the pandemic including a greater utilization of telemedicine.