Pre-Exposure Prophylaxis Care Engagement Among Men Who Have Sex with Men in the United States During the COVID-19 Pandemic: A Scoping Review.

The COVID-19 pandemic substantially impacted the pre-exposure prophylaxis (PrEP) care continuum among men who have sex with men (MSM). While PrEP use during the pandemic has been studied, regional differences in PrEP regulations highlight the need for U.S.-specific reviews. This scoping review evaluates empirical literature on COVID-19's impact on PrEP engagement among U.S. MSM. A systematic search on August 29, 2024, identified articles from PubMed, PsycINFO, and Embase. Eligible studies (a) collected empirical data from U.S. MSM, (b) assessed COVID-19's impact on PrEP engagement, and (c) were peer-reviewed, English-language, full-text articles. Standardized forms were used to extract study information. Study quality was appraised using validated tools for qualitative and quantitative research. Findings were synthesized using descriptive statistics and narrative summaries, categorized by distinct pandemic phases. Of 438 records, 21 studies were included (15 quantitative, five qualitative, one mixed-method), mostly conducted during the lockdown phase. Results showed reduced PrEP use (5.9-35.6%), increased missed doses (8.3-14.2%), and higher discontinuation rates (9.0-33.3%) during COVID-19. Barriers included refill issues (9.0-20.0%), limited access to care (2.5-17.0%), disrupted lab testing (~ 25.5%), and changes in clinic procedures. College-aged youth reported confidentiality concerns after returning home. Qualitative evidence highlighted telehealth and injectable PrEP as promising alternatives. This review reveals significant disruptions to PrEP care for U.S. MSM during COVID-19, a lack of post-lockdown research, underrepresentation of MSM from Northeastern and Pacific regions, and limited use of objective PrEP adherence measures. These findings underscore the need for emergency-prepared PrEP services and expanded telehealth and home-delivery options for future crises.