(P298) Loss to follow-up in the Dutch PrEP pilot program

Background: HIV pre-exposure prophylaxis (PrEP) care has been offered through a Dutch national pilot program at Sexual Health Centers (SHCs) since mid-2019. Other health care providers such as GPs can prescribe PrEP, but out-of-pocket costs are higher and availability is limited. The pilot program is intended for those at high risk for HIV as determined at program entry and is currently at capacity (8.500 places). Lowered risk for HIV is the most commonly cited reason among those who stop participating in the program. For participants who are lost to follow-up (LTFU), reasons for exiting the program are unknown. Therefore, we analyzed associations of demographic and behavioral factors with LTFU.

Methods: We used data from the last PrEP pilot program consultation from men who have sex with men (MSM) who participated between July 2019 and June 2022. LTFU was defined as having no PrEP consultation for ≥7 months. We used mutually adjusted logistic regression models to analyze associations of demographics and sexual behavior with LTFU. Models were further adjusted for SHC region and participants’ total number of PrEP consultations.

Results: Of 8.313 participating MSM, 1.687 (20%) were LTFU. Higher age and higher number of partners were negatively associated with LTFU. Chemsex, no condomless anal sex, no recent PrEP use, and on-demand PrEP use (vs daily; among recent PrEP users) were positively associated with LTFU.

Conclusion: Our results indicate that MSM who were LTFU may have a lower risk-behavior profile at their last consultation than those who continue participation. However, potentially more vulnerable groups, those with a younger age and those engaging in chemsex, were more likely to be LTFU. Further insight is needed into reasons for LTFU and possible behavior changes over time in these groups.