Lost and Not Found: Determinants and Patterns of Loss to Follow-Up Among Men Who Have Sex With Men in the Dutch HIV Pre-Exposure Prophylaxis Pilot Program.

INTRODUCTION

One of the challenges of a national HIV pre-exposure prophylaxis (PrEP) program is continuation of PrEP use and retention in care. The aim of this study was to explore determinants of loss to follow-up (LTFU) among men who have sex with men (MSM) in the Dutch national PrEP pilot program.

METHODS

Data from the national STI surveillance database between July 1, 2019, and December 31, 2022, were used of all 3-monthly PrEP pilot consultations among MSM who had at least 2 consultations. LTFU was defined as having no consultation for ≥7 months, and was further divided into "missed consultation/restarted" and "definitive LTFU." We used mutually adjusted, multivariable, multistate, time-homogenous Markov models to analyze demographic and behavioral associations with LTFU.

RESULTS

A total of 8948 participants (62,158 consultations) were included, of which 30% were LTFU at some point. Young participants and on-demand/nonrecent PrEP users (ie, in the past 3 months) were more likely to become LTFU. Participants who had ≥6 partners (vs 0-2) in the past 6 months or were ≥25 years of age (vs <25) were less likely to become LTFU. In addition, non-Dutch origin was associated with missed consultation/restarted and definitive LTFU. Furthermore, having had no (condomless) anal sex in the past 6 months was associated with missed consultation/restarted.

CONCLUSIONS

Specific characteristics of MSM who were LTFU, such as young age, non-Dutch origin, and on-demand PrEP use, may be used to implement targeted interventions to increase PrEP retention and possibly prevent new HIV infections among PrEP users.