Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Haoyi Wang; Oladipupo Shobowale; Chantal den Daas; Eline Op de Coul; Bouko Bakker; Aryanti Radyowijati; Koenraad Vermey; Arjan van Bijnen; Wim Zuilhof; Kai J Jonas

doi:10.3390/ijerph19148829

Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Int J Environ Res Public Health. 2022 Jul 20;19(14):8829. doi: 10.3390/ijerph19148829.

Authors

Affiliations

¹ Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands.
² Health Psychology, University of Aberdeen, Aberdeen AB24 3 FX, UK.
³ Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands.
⁴ Rutgers, 3511 MJ Utrecht, The Netherlands.
⁵ ResultsinHealth, 2352 BN Leiderdorp, The Netherlands.
⁶ Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands.

Abstract

PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

Keywords: HIV prevention; MSM; PrEP use/uptake; socio-spatial analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Intention
Male
Netherlands
Pre-Exposure Prophylaxis*
Sexual and Gender Minorities*
Spatial Analysis

Grants and funding

EMIS-2017 occurred as part of ESTICOM (European Surveys and Training to Improve MSM Community Health), a 3-year project funded by the European Commission Health Programme 2014–2020 through a tender commissioned by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA) to deliver evidence about the sexual health of gay men, bisexual men and other MSM across Europe. For this study there is no additional funding source to declare.