Putting PrEP into practice Studies on oral HIV PrEP in the Netherlands

Oral HIV pre-exposure prophylaxis (PrEP) is a safe and effective biomedical tool to prevent HIV infection. Oral PrEP first became available in the Netherlands through the Amsterdam PrEP demonstration project (AMPrEP, 2015-2020) Access was expanded through the National PrEP Pilot Programme (NPP) from 2019 until 2024.
This thesis studied PrEP use, sexual behavior, and the incidence of HIV and other sexually transmitted infections (STI) among men who have sex with men (MSM) and transgender or genderdiverse (TGD) persons. Data from AMPrEP showed that over four years of PrEP use, medication adherence remained high and STI incidence did not increase over time. Data from the NPP revealed disparities in PrEP- and HIV-related outcomes: certain subpopulations (young MSM, TGD persons, sex workers, migrants, uninsured persons) were more likely to be PrEP-inexperienced before joining the NPP, test positive for HIV during PrEP intake, and drop out from PrEP care. While the number of HIV diagnoses among MSM decreased after NPP implementation, HIV diagnoses among sex workers and TGD persons increased. In a community-participatory study, we examined barriers and facilitators to care among TGD migrants. Interviews revealed that accumulating and interacting factors on the individual, interpersonal, and systemic level affected access to care. Finally, we assessed the impact of reduced-frequency PrEP monitoring, an intervention that could lower the burden of PrEP care for both user and clinic, on STI diagnoses and associated care. Reduced-frequency monitoring would result in more efficient STI testing and fewer antibiotic prescriptions, without evidence of more chlamydia or gonorrhea transmission.