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) effectively prevents HIV in women, especially adolescent girls and young women. However, the COVID-19 lockdown disrupted access to healthcare services, impacting PrEP outcomes.

This study analyses data from the TB/HIV Care program in the Dr. Kenneth Kaunda District, North-West Province, South Africa, from December 2018 to December 2021. It evaluates changes in PrEP initiation, uptake, and adherence among women aged 16 and older, comparing the pre-pandemic (December 2018 to February 2020) and pandemic (March 2020 to December 2021) periods using Bayesian regression models.

A total of 1,339 women engaged in transactional sex were counselled about PrEP services, with 776 initiating treatments at an average age of 33. Pre- lockdown trends in PrEP initiation were disrupted during the lockdown, exhibiting subsequent changes. Although there was no significant increase in PrEP uptake among clients tested within a month, a modest, statistically significant upward trend was observed over time.

The initiation and adherence to PrEP decreased despite innovative interventions implemented during lockdowns. Although there was a slight improvement in uptake after the lockdown, the interventions had a limited effect. These findings highlight the necessity for resilient health system structures and recognize the limitations posed by pandemic-related disruptions that may have hindered implementation and measurement efforts.

The study highlighted decreased initiation, uptake, and adherence to PrEP during the COVID-19 lockdown, emphasising the need for innovative strategies to enhance HIV control and prepare for potential future pandemics.