TY - JOUR
T1 - Pre-exposure prophylaxis among men who have sex with men in the Amsterdam Cohort Studies
T2 - Use, eligibility, and intention to use
AU - Coyer, Liza
AU - van Bilsen, Ward
AU - Bil, Janneke
AU - Davidovich, Udi
AU - Hoornenborg, Elske
AU - Prins, Maria
AU - Matser, Amy
PY - 2018
Y1 - 2018
N2 - OBJECTIVE: Currently, HIV pre-exposure prophylaxis (PrEP) is not covered by health insurance in the Netherlands. We examined time trends in use of PrEP, characteristics of PrEP users, PrEP eligibility and intention to use PrEP among HIV-negative men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (ACS).DESIGN: Prospective cohort study.METHODS: We used data from four 6-monthly questionnaire waves, collected between 2015-2017. PrEP use over time was examined in logistic regression models using generalized estimating equations. Using descriptive statistics, we compared PrEP users before first-time initiation to non-PrEP-users. We used national guidelines to assess PrEP eligibility.RESULTS: We included 687 MSM. Median age was 40 (IQR 33-47) years in 2015. Recent PrEP use was reported by 57/687 (8%) MSM. PrEP use increased over calendar time (P<0.001) to 7% in 2017. PrEP users did not differ from non-PrEP users in socio-demographic characteristics, but reported a significantly higher median number of casual sex partners, more often reported condomless anal sex and chemsex with casual partners, and more often had an sexually transmitted infection in the preceding 6 months (all P<0.05). PrEP eligibility increased over time, but the effect was not statistically significant (P = 0.075). PrEP eligibility criteria were met by 149/460 (32%) at wave 4, of whom 31/149 (21%) reported use of PrEP. The proportion with a high intention to use PrEP was greater among eligible than non-eligible MSM (51% vs. 24%, P<0.001).CONCLUSION: PrEP use increased over time but remained under 10%, even though 32% met the eligibility criteria, of whom 51% had a high intention to use PrEP. This suggests that a large proportion of Dutch MSM at risk could benefit from PrEP.
AB - OBJECTIVE: Currently, HIV pre-exposure prophylaxis (PrEP) is not covered by health insurance in the Netherlands. We examined time trends in use of PrEP, characteristics of PrEP users, PrEP eligibility and intention to use PrEP among HIV-negative men who have sex with men (MSM) participating in the Amsterdam Cohort Studies (ACS).DESIGN: Prospective cohort study.METHODS: We used data from four 6-monthly questionnaire waves, collected between 2015-2017. PrEP use over time was examined in logistic regression models using generalized estimating equations. Using descriptive statistics, we compared PrEP users before first-time initiation to non-PrEP-users. We used national guidelines to assess PrEP eligibility.RESULTS: We included 687 MSM. Median age was 40 (IQR 33-47) years in 2015. Recent PrEP use was reported by 57/687 (8%) MSM. PrEP use increased over calendar time (P<0.001) to 7% in 2017. PrEP users did not differ from non-PrEP users in socio-demographic characteristics, but reported a significantly higher median number of casual sex partners, more often reported condomless anal sex and chemsex with casual partners, and more often had an sexually transmitted infection in the preceding 6 months (all P<0.05). PrEP eligibility increased over time, but the effect was not statistically significant (P = 0.075). PrEP eligibility criteria were met by 149/460 (32%) at wave 4, of whom 31/149 (21%) reported use of PrEP. The proportion with a high intention to use PrEP was greater among eligible than non-eligible MSM (51% vs. 24%, P<0.001).CONCLUSION: PrEP use increased over time but remained under 10%, even though 32% met the eligibility criteria, of whom 51% had a high intention to use PrEP. This suggests that a large proportion of Dutch MSM at risk could benefit from PrEP.
KW - Adult
KW - Anti-HIV Agents/therapeutic use
KW - HIV Infections/prevention & control
KW - Homosexuality, Male/psychology
KW - Humans
KW - Intention
KW - Male
KW - Middle Aged
KW - Netherlands
KW - Pre-Exposure Prophylaxis/statistics & numerical data
KW - Prospective Studies
KW - Surveys and Questionnaires
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85054888624&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30312336
U2 - https://doi.org/10.1371/journal.pone.0205663
DO - https://doi.org/10.1371/journal.pone.0205663
M3 - Article
C2 - 30312336
SN - 1932-6203
VL - 13
JO - PLOS ONE
JF - PLOS ONE
IS - 10
M1 - e0205663
ER -