Pre-exposure Prophylaxis Outcomes During the COVID-19 Lockdown Period among Women in the North-West Province, South Africa: A Retrospective Analysis

Oral Pre-Exposure Prophylaxis (PrEP) is a proven method for preventing HIV among women, including adolescent girls and young women who are categorised as priority populations due to a higher risk of HIV acquisition. However, the COVID-19 lockdown disrupted access to healthcare services, including those for HIV prevention and treatment. This study aimed to assess changes in PrEP outcomes before and during the COVID-19 lockdown period among women in the North-West Province, South Africa.

We conducted a retrospective analysis of programme data collected by TB HIV Care from December 2018 to December 2021 in the Dr Kenneth Kaunda District to assess changes in PrEP initiation, uptake, and adherence before (December 2018 - February 2020) and during (March 2020 - December 2021) the COVID-19 pandemic among women aged 16 years and above. The Department of Health electronic (Excel) register was used to collect data. The overdispersion tests conducted on three datasets, PrEP initiation, uptake, and adherence, showed significant overdispersion (with p-values less than 0.05). This indicates that the Negative Binomial regression model is more appropriate for these datasets. Additionally, the adherence dataset contained a high percentage of zero outcomes, underscoring the need for a zero-inflated model to address the excess zeros. Consequently, we implemented Bayesian negative binomial regression models for both the PrEP initiation and uptake datasets and a Bayesian Zero-Inflated Negative Binomial (ZINB) regression model for the adherence dataset.

A total of 1339 women involved in transactional sex were counselled and offered PrEP services. Out of these, 776 were initiated on PrEP with a mean age of 33 years. PrEP initiation demonstrated a significant trend before the lockdown, an immediate effect during the lockdown, and a shift in trends afterwards, with all 95% credible intervals excluding zero. This suggests that the pandemic both disrupted and altered PrEP initiation patterns. The intervention did not lead to a significant increase in PrEP uptake among clients who returned for HIV testing within one month, as the 95% credible intervals included the value of 1. Nonetheless, there was a slight positive trend over time that was statistically significant, indicating a modest increase in uptake. Additionally, none of the estimated parameters for adherence achieved statistical significance, suggesting that the intervention did not have a meaningful impact on adherence levels.

The study revealed a decline in the initiation, uptake, and adherence to PrEP during the COVID-19 lockdown, although services were maintained through innovative interventions. These findings underscore the necessity for more innovative strategies to enhance PrEP outcomes, ensure effective HIV control, and prepare for potential future pandemics.