Disparities in United States Nationwide County-Level PrEP Rate and PrEP to Need Ratio During the COVID-19 Pandemic

Background The COVID-19 pandemic created numerous barriers to pre-exposure prophylaxis (PrEP) access in the United States (US). The present study aimed to understand changes in county-level PrEP use relative to the need for PrEP during the COVID-19 pandemic, particularly for racial minorities. Method Public county-level data from 2019 to 2022 were used. Linear mixed models with multiple imputations and adjusting for covariates were used to examine changes in PrEP rate and PrEP to need ratio (PNR) across time. We also assessed PNR and PrEP rate across time allowing for race and time interactions. Finally, we examined PNR and PrEP rate among age groups over time. Results There was no difference in PrEP prevalence between 2019 and 2020 (p > 0.05). However, compared to 2019, PrEP prevalence was higher in 2021 and 2022 (p < .05). There was no change in PNR in 2020 or 2021 from 2019 (p > 0.05). Compared with 2019, PNR increased in 2022 (p < 0.05). Non-Hispanic Black population concentration did not predict the PrEP rate in 2020 or 2021 (p > 0.05), though it did predict a slight increase in PrEP prevalence in 2022 relative to 2019 (p < 0.05). Concentration non-Hispanic Black population did not predict PNR in any year (p > 0.05). Conclusion Although PrEP use began increasing from pre-pandemic levels by 2021, PNR increases did not occur until 2022. Increases in PNR did not occur in areas with greater concentrations non-Hispanic Black individuals, suggesting disparities worsened during the pandemic. Addressing racial disparities is key in responding to COVID-19 related disruptions to HIV prevention efforts.