Subpopulations with frequent healthcare barriers have increased risk of sexually transmitted infections and dropping out from HIV preexposure prophylaxis care.

OBJECTIVE

Certain subpopulations (i.e., <25 years, transgender, sex worker, uninsured or migrant) were prioritized for inclusion in the Dutch preexposure prophylaxis (PrEP) pilot. We compared incidence of sexually transmitted infections (STI) during and drop-out from HIV PrEP care between prioritized and nonprioritized subpopulations.

DESIGN

Retrospective longitudinal study using routinely collected data at the Centre for Sexual Health Amsterdam, 2019-2024.

METHODS

We modelled incidence rates (IR) for any STI while on PrEP using Poisson regression, adjusting for testing frequency and calendar time. We modelled the probability of early loss-to-follow-up (LTFU) (i.e., no PrEP follow-up visit within 12 months of enrolment) using logistic regression, adjusting for sexual behaviour. We modelled the probability of later LTFU (i.e., no PrEP visit within 12 months of a prior PrEP follow-up visit) using competing risk regression, adjusting for sexual behaviour. We added subpopulations as indicator variables to all models to compare endpoints between groups.

RESULTS

Of 4781 individuals included (median age 32 years, IQR = 26-40), 50.2% ( n = 2402) belonged to prioritized subpopulations. The IR of any STI was 101.6/100 person-years. STI IR were higher among those belonging to prioritized groups (except for the transgender group). 494 individuals had early LTFU, which was associated with age <25 years, reporting sex work, and being a migrant. Later LTFU occurred 933 times and was associated with age <25 years, being transgender, and reporting sex work.

CONCLUSION

People belonging to prioritized subpopulations had more STIs and were more often LTFU from PrEP care. Targeted interventions to support PrEP retention and prevent STIs are needed.