BACKGROUND:: The coronavirus disease 2019 (COVID-19) pandemic continues to put strain on health systems in the United States, leading to significant shifts in the delivery of routine clinical services, including those offering HIV pre-exposure prophylaxis (PrEP). We aimed to assess whether individuals discontinued PrEP use at higher rates during the COVID-19 pandemic and the extent to which disruptions to usual clinical care were mitigated through telehealth. METHODS:: Using data from an ongoing prospective cohort of men who have sex with men (MSM) newly initiating PrEP in three mid-sized cities (n = 195), we calculated the rate of first-time discontinuation of PrEP use in the period prior to the COVID pandemic and during the COVID-19 pandemic and compared these rates using incidence rate ratios (IRRs). Further, we compared the characteristics of patients who discontinued PrEP use during these periods to those who continued to use PrEP during both periods. RESULTS:: Rates of PrEP discontinuation prior to the COVID pandemic and during the COVID-19 pandemic were comparable (4.29 vs. 5.20 discontinuations per 100 person-months; incidence rate ratio [IRR]: 1.95; 95% confidence interval [CI]: 0.83–1.77). While no significant differences in the PrEP discontinuation rate were observed in the overall population, the rate of PrEP discontinuation increased by almost three-fold among participants aged 18 to 24 years old (IRR: 2.78; 95% CI: 1.48–5.23) and by 29% among participants covered by public insurance plans at enrollment (IRR: 1.29; 95% CI: 1.03, 5.09). Those who continued to use PrEP were more likely to have had a follow-up clinical visit via telehealth in the early months of the pandemic (45% vs. 17%). CONCLUSION:: In this study, rates of PrEP discontinuation were largely unchanged with the onset of the COVID-19 pandemic. The use of telehealth likely helped retain patients in PrEP care and should continue to be offered in the future.