Abstract: Journal Pre-proof Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis Raphael B. Stricker, Melissa C. Fesler PII: S1876-0341(21)00219-7 DOI: https://doi.org/10.1016/j.jiph.2021.08.001 Reference: JIPH 1661 To appear in: Journal of Infection and Public Health Received Date: 25 March 2021 Revised Date: 12 July 2021 Accepted Date: 1 August 2021 Please cite this article as: Stricker RB, Fesler MC, Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis, Journal of Infection and Public Health (2021), doi: https://doi.org/10.1016/j.jiph.2021.08.001 This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier. Hydroxychloroquine Pre-Exposure Prophylaxis for COVID-19 in Healthcare Workers from India: A Meta-Analysis. re Square Medical Associates, San Francisco, CA, USA. Correspondence: lP 1Union -p ro of Raphael B. Stricker, MD,1 and Melissa C. Fesler, FNP-BC.1 Raphael B Stricker Union Square Medical Associates ur na 450 Sutter Street, Suite 1504 San Francisco, CA 94108, USA Tel +1 415-399-1035 Jo Email rstricker@usmamed.com Key Words: COVID-19; SARS-CoV-2; Pre-exposure prophylaxis; Hydroxychloroquine; Vaccine Word count: 435 Running Title: Hydroxychloroquine PrEP Meta-Analysis To date, the COVID-19 pandemic has resulted in more than 180 million cases of SARS-CoV-2 infection and more than four million deaths world-wide.1 Although novel COVID-19 vaccines have become clinically available, the safety and efficacy of these vaccines remains open to question.2 Alternate approaches to prevention of disease have received little attention, and one medication, hydroxychloroquine (HCQ), has been attacked and dismissed based on flawed studies and political controversy that obscured the value of this treatment as pre-exposure prophylaxis (PrEP) for SARS-CoV-2 infection. of A British study of 120,075 healthcare workers (HCWs) found that these subjects had a 7-8 fold greater risk of developing severe COVID-19 compared to non-HCWs.3 With this background, ro the Indian Council of Medical Research (ICMR) National Taskforce for COVID-19 formulated guidelines for weekly HCQ PrEP in high-risk HCWs.4 We used internet search engines to -p identify 11 cohort studies of weekly HCQ PrEP in HCWs from India based on the ICMR protocol.5-15 These case-control studies enrolled a total of 7,616 high-risk HCWs who were re tested for SARS-CoV-2 infection as an endpoint after varying lengths of time following weekly lP HCQ PrEP or no treatment. We have performed a preliminary meta-analysis of these studies, as shown in Table 1. In the 11 studies that included HCWs who used any HCQ PrEP, the infection rate was significantly ur na decreased (RR 0.56, p=0.0040). In the five studies that included HCWs who took at least six doses of weekly HCQ PrEP, the infection rate was reduced even further (RR 0.25,..