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
Year: 2025
Type: article
Study design: Observational Study
Abstract: 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.
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4417459068