Postexposure prophylaxis during COVID-19 lockdown in Melbourne, Australia

The Australian government introduced several lockdown measures in the state of Victoria on March 23, 2020, in response to the COVID-19 pandemic. The lockdown measures included the introduction of physical distancing, closure of non-essential services, the banning of indoor gatherings, shift to working from home for those who could, and restrictions requiring people to stay at home unless necessary for essential shopping, medical needs, exercise, or caring roles. Data from 56 Dean Street in London, UK, showed an 80% reduction in HIV postexposure prophylaxis (PEP) prescriptions in the first 4 weeks after the implementation of a similar lockdown in the UK.¹ We expected to see a similar reduction in PEP prescriptions in Australia from reduced casual sex during the lockdown and were interested in how quickly causal sex would resume.

The Melbourne Sexual Health Centre (MSHC) is the major public HIV and STI clinic located in the city of Melbourne, VIC, Australia. During the lockdown period, MSHC remained open and face-to-face consultations were provided after an initial assessment of the risk of COVID-19 via the phone. The MSHC provides free PEP to individuals after clinical assessment. In 2019, 1279 PEP prescriptions were given at MSHC (unpublished). We examined the changes in weekly PEP prescriptions at MSHC before and during the COVID-19 lockdown period. This study was approved by the Alfred Hospital Ethics Committee (301/20).

Between Jan 6 and May 31, 2020, 368 PEP prescriptions were given to 346 individuals at MSHC. The median age of the patients was 29 years (IQR 26–34). Most PEP consultations were provided to men (n=347 [94%]) and a small proportion of women (n=10 [3%]) and individuals who are transgender or have other gender identities (n=11 [3%]). Of the 347 PEP consultations had with men, 330 (95%) were men who have sex with men (MSM). The number of PEP prescriptions remained around 20–30 each week before the lockdown (Jan 6–March 22) but decreased to 11 during the first week of the lockdown (March 23–29) with a nadir of two PEP prescriptions in the fourth week of the lockdown (April 13–19; appendix p 1). However, the number of PEP prescriptions increased after April 20 to approach levels before lockdown.

The median number of weekly PEP prescriptions before lockdown (Jan 6–March 22) was 21 (IQR 19–26), which was significantly higher than the median weekly number during lockdown (eg, March 23–May 31 median 11 [IQR 8–17]). Furthermore, comparing data from the 4 weeks before lockdown (Feb 24–March 22) with the first 4 weeks during lockdown (March 23–April 19), a 66% reduction was seen, from 88 to 30 PEP prescriptions. No differences were seen in the median age (Mann-Whitney U test p=0·376), sex (χ² test p=0·172), or proportion who were MSM (χ² test p=0·424) before and after lockdown. Notably, four female sex workers accessed PEP before lockdown but none during the lockdown period, which might be due to the closure of brothels during the lockdown. 19 individuals received more than one PEP prescription during the study period (16 individuals had two PEP prescriptions and three individuals had three PEP prescriptions). 12 individuals received the repeated PEP prescriptions before and during the lockdown period, five individuals only received the repeated PEP prescriptions before the lockdown period, and two individuals only received the repeated PEP prescription during the lockdown period.

The reduction in PEP prescriptions during the lockdown period at our clinic was similar to the size of the reduction observed at 56 Dean Street in London (66% vs 80% for the 4 weeks before and after lockdown).¹ Both Australia and the UK implemented lockdown measures on the same day (March 23, 2020), and a substantial reduction in PEP prescriptions was observed immediately after the implementation of the lockdown. The reduction in PEP prescriptions we saw was slightly lower than that seen at 56 Dean Street, which might be because the COVID-19 epidemic in England (5585 cases as of March 22)² was larger than in Australia (1765 cases as of March 22).³ The reduction observed at MSHC might have been due to reduced sexual risk during the COVID lockdown period rather than reduced access to services,⁴ given our walk-in service remained open and accessible throughout the period.

Since the nadir of PEP prescriptions in the week of April 13–19, a relatively rapid increase in prescriptions was seen during the lockdown period reaching 17 prescriptions (May 11–17) and 20 prescriptions (May 18–24) in the 2 weeks immediately after restrictions began to on May 13, 2020, and individuals were allowed to visit friends and family indoors with no more than five visitors.⁵ If PEP prescriptions are used as a proxy for risky behaviour then our data suggest that any decrease in HIV and STI diagnoses will be temporary.