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Antiretroviral prophylaxis started within 72 hours of a possible exposure is a feasible and cost-effective measure to prevent HIV infection.1 In Spain, post-exposure prophylaxis (PEP) is provided free-of-charge via a hospital-based HIV specialist. As the COVID-19 pandemic rages across the world, questions are emerging on its impact on routine healthcare. Spain imposed a national lockdown on 14 March 2020, with the strictest measures applied to the Madrid region, the epicentre of the epidemic.2 The state of emergency remained in effect through 21 June. We retrospectively compared PEP prescription data in the period January–May of 2020 and 2019 from 20 hospitals serving 5.5 million Madrid residents (79% of the region population). The number prescribed PEP overall fell from 556 in 2019 (100.8 cases/million population) to 348 in 2020 (63.1/million), a decrease of 37%. During the lockdown period, prescriptions decreased from 265 (48/million) to 58 (10.5/million), a decrease of 78%. Our data are similar to those recently reported from London.3 Of note, prescriptions started to increase again before de-escalation officially started. We believe these data may indicate some kind of relaxation in the perception of the risk of HIV infection as the end of the lockdown approached. The reduction in PEP use may reflect changes in sexual behaviour during lockdown. Nevertheless, difficulties to access PEP due to fear of SARS-CoV-2 or imposition of fines by law enforcement could also be considered. Moreover, although other methods of acquisition could be contemplated, PEP internet access is highly restricted in our country. Impact on new HIV diagnoses should be assessed.
Handling editor Anna Maria Geretti
Collaborators Madrid HIV Pharmaceutical Care Group: Oscar Pinar, Ana Ontañón, María Ángeles Campos, Elena García-Benayas, Concepción Martínez, Carlos Folguera, Jose Alberto Peña, Laura García, Virginia Collado, Francisco Moreno, Laura Corrales, Elena Matilla, Irene Cañamares, Elena Tortajada, Cristina Capilla.
Contributors Al authors have contributed to the planning, conduct and reporting of the work described in the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.