TY - JOUR
T1 - The impact of COVID-19-related restrictions in 2020 on sexual healthcare use, pre-exposure prophylaxis use, and sexually transmitted infection incidence among men who have sex with men in Amsterdam, the Netherlands
AU - de la Court, Feline
AU - Boyd, Anders
AU - Coyer, Liza
AU - van den Elshout, Mark
AU - de Vries, Henry J. C.
AU - Matser, Amy
AU - Hoornenborg, Elske
AU - the HIV Transmission Elimination AMsterdam, H-TEAM) Consortium
AU - Prins, Maria
N1 - Funding Information: No conflicts of interest were declared by the authors for the execution of the current study within the OptiPrEP project. However, for the AMPrEP cohort study (from which data are used for the current study), conflict of interest is reported by EH, MP, and HJCdV. EH has received advisory board fees from Gilead Sciences and speaker fees from Janssen‐Cilag, both paid to her institution. MP obtained unrestricted research grants and speaker fees from Gilead Sciences, Roche, AbbVie, and MSD, paid to her institute. HJCdV has received grants from Medigene and advisory board and speaker fees from Gilead Sciences, Medigene, AbbVie, Janssen‐Cilag, and Willpharma, paid to his institution. All other authors declare no conflict of interests for the AMPrEP study. Funding Information: The current study is part of the OptiPrEP (optimizing pre‐exposure prophylaxis roll‐out among men having sex with men) project, funded by the Aidsfonds (P‐54601). The OptiPrEP project involves secondary data analysis of existing databases that measure PrEP use, including the AMPrEP cohort study. The AMPrEP study was approved by the ethics board of the Academic Medical Center Amsterdam, the Netherlands (NL49504·018·14) and received funding as part of the H‐TEAM initiative from ZonMw (522002003), National Institute for Public Health and the Environment, and Public Health Service of Amsterdam. Study drug was provided by Gilead Sciences. The H‐TEAM initiative is supported by Aidsfonds (grant number: 2013169), Amsterdam Dinner Foundation, Bristol‐Myers Squibb International Corp. (study number: AI424‐541), Gilead Sciences Europe Ltd (grant number: PA‐HIV‐PREP‐16‐0024), Gilead Sciences (protocol numbers: CO‐NL‐276‐4222, CO‐US‐276‐1712), M.A.C AIDS Fund. Funding Information: Academic Medical Center Amsterdam; Aids Fonds; Amsterdam Dinner Foundation; Bristol‐Myers Squibb International Corp.; Gilead Sciences; Gilead Sciences Europe Ltd; M.A.C AIDS Fund; Rijksinstituut voor Volksgezondheid en Milieu; ZonMw Funding information Publisher Copyright: © 2022 British HIV Association.
PY - 2023/2
Y1 - 2023/2
N2 - Objectives: We studied the effects of restrictions related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic on the use of sexual healthcare and pre-exposure prophylaxis (PrEP) and on the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) in a prospective, open-label PrEP demonstration study (AMPrEP) in Amsterdam, the Netherlands. Methods: We retrieved data from 2019 to 2020 for participants with one or more study visit in 2019 (n = 305) and from two COVID-19 questionnaires (2020: n = 203; 2021: n = 160). Analyses were stratified for three periods of pandemic-related restrictions (first: 15 March 2020–15 June 2020; second: 16 June 2020–15 September 2020; third: 16 September 2020–31 December 2020 or 1 April 2021 for the COVID-19 questionnaire). Endpoints included returning for care during the pandemic, PrEP use (increased/unchanged vs. deceased/stopped, relative to 2019), and any STI/HIV. We modelled determinants of care and PrEP use via multivariable logistic regression and STI incidence using piecewise Poisson regression, comparing the 2020 and 2019 periods. Results: Of the 305 MSM included in the analysis, 72.8% returned for care during the pandemic, and this was significantly more likely among daily (vs. event-driven) PrEP users (p < 0.001). Increased/unchanged PrEP use ranged from 55.2% to 58.1% across the three pandemic periods and was more likely among those reporting chemsex in the first (p = 0.001) and third (p = 0.020) periods and among those reporting an increased/unchanged number of sex partners during the second period (p = 0.010). STI incidence was significantly lower in 2020 than in 2019 during the first period (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.28–0.68) and not significantly different during the second (IRR 1.38; 95% CI 0.95–2.00) and third (IRR 1.42; 95% CI 0.86–2.33) periods. No HIV was diagnosed. Conclusion: COVID-19-related restrictions coincided with reduced care and PrEP use. Changes in STI incidence suggest delayed diagnoses. Ways to ensure continued access to sexual healthcare during restrictions are needed.
AB - Objectives: We studied the effects of restrictions related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic on the use of sexual healthcare and pre-exposure prophylaxis (PrEP) and on the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) in a prospective, open-label PrEP demonstration study (AMPrEP) in Amsterdam, the Netherlands. Methods: We retrieved data from 2019 to 2020 for participants with one or more study visit in 2019 (n = 305) and from two COVID-19 questionnaires (2020: n = 203; 2021: n = 160). Analyses were stratified for three periods of pandemic-related restrictions (first: 15 March 2020–15 June 2020; second: 16 June 2020–15 September 2020; third: 16 September 2020–31 December 2020 or 1 April 2021 for the COVID-19 questionnaire). Endpoints included returning for care during the pandemic, PrEP use (increased/unchanged vs. deceased/stopped, relative to 2019), and any STI/HIV. We modelled determinants of care and PrEP use via multivariable logistic regression and STI incidence using piecewise Poisson regression, comparing the 2020 and 2019 periods. Results: Of the 305 MSM included in the analysis, 72.8% returned for care during the pandemic, and this was significantly more likely among daily (vs. event-driven) PrEP users (p < 0.001). Increased/unchanged PrEP use ranged from 55.2% to 58.1% across the three pandemic periods and was more likely among those reporting chemsex in the first (p = 0.001) and third (p = 0.020) periods and among those reporting an increased/unchanged number of sex partners during the second period (p = 0.010). STI incidence was significantly lower in 2020 than in 2019 during the first period (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.28–0.68) and not significantly different during the second (IRR 1.38; 95% CI 0.95–2.00) and third (IRR 1.42; 95% CI 0.86–2.33) periods. No HIV was diagnosed. Conclusion: COVID-19-related restrictions coincided with reduced care and PrEP use. Changes in STI incidence suggest delayed diagnoses. Ways to ensure continued access to sexual healthcare during restrictions are needed.
KW - COVID-19
KW - men who have sex with men
KW - pre-exposure prophylaxis
KW - sexual healthcare use
KW - sexually transmitted infections
UR - http://www.scopus.com/inward/record.url?scp=85140065227&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/hiv.13374
DO - https://doi.org/10.1111/hiv.13374
M3 - Article
C2 - 36226479
SN - 1464-2662
VL - 24
SP - 212
EP - 223
JO - HIV medicine
JF - HIV medicine
IS - 2
ER -