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Meta-Analysis
. 2024 Nov 1;97(3):208-215.
doi: 10.1097/QAI.0000000000003488. Epub 2024 Oct 7.

A Systematic Review and Meta-analysis of the Impact of the COVID-19 Pandemic on Access to HIV Pre-exposure Prophylaxis: Lessons for Future Public Health Crises

Luh Putu Lila Wulandari  1 , Srila Nirmithya Salita Negara  2 , Yusuf Ari Mashuri  2 , Siska Dian Wahyuningtias  2 , I Wayan Cahyadi Surya Distira Putra  2 , Yanri W Subronto  2   3 , Riris Andono Ahmad  2   4 , Hasbullah Thabrany  5 , Rebecca Guy  1 , Matthew Law  1 , Mohamed Hammoud  1 , Benjamin B Bavinton  1 , John Kaldor  1 , Nicholas Medland  1 , Marco Liverani  6   7 , Ari Probandari  2 , David Boettiger  1 , Virginia Wiseman  1   6
Affiliations
Meta-Analysis

A Systematic Review and Meta-analysis of the Impact of the COVID-19 Pandemic on Access to HIV Pre-exposure Prophylaxis: Lessons for Future Public Health Crises

Luh Putu Lila Wulandari et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The World Health Organization is committed to strengthening access to pre-exposure prophylaxis (PrEP) for HIV prevention and its integration into primary care services. Unfortunately, the COVID-19 pandemic has disrupted the delivery of primary care, including HIV-related services. To determine the extent of this disruption, we conducted a systematic review and meta-analysis of the changes in access to PrEP services during the pandemic and the reasons for these changes.

Methods: A search was conducted using PubMed, Scopus, Embase, PsycINFO, and Cinahl for studies published between January 2020 and January 2023. Selected articles described self-reported disruptions to PrEP service access associated with the COVID-19 pandemic or its responses. Pooled effect sizes were computed using a random-effects model.

Results: Thirteen studies involving 12,652 PrEP users were included in our analysis. The proportion of participants reporting a disruption in access to PrEP services during the COVID-19 pandemic ranged from 3% to 56%, with a pooled proportion of 21% (95% confidence intervals: 8% to 38%). Social restrictions, financial constraints, and limited health insurance coverage were key factors affecting access to PrEP services during the pandemic.

Conclusions: To our knowledge, this is the first meta-analysis to quantify the extent of disruptions to accessing PrEP services because of the COVID-19 pandemic. To increase the ability of primary care services to maintain PrEP services during public health crises, a mixture of strategies is worth considering. These include multi-month PrEP prescriptions, telehealth services, deployment of peer support groups to provide a community-based service or home delivery, and provision of financial support interventions.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Study selection.
FIGURE 2.
FIGURE 2.
Forest plot of the proportion of PrEP users experiencing disruptions in access to PrEP services during the COVID-19 pandemic.
See this image and copyright information in PMC

References

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