Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
stichting hiv monitoring, Amsterdam, the Netherlands.
HIV Med. 2023 Feb;24(2):212-223. doi: 10.1111/hiv.13374. Epub 2022 Oct 13.
OBJECTIVES: We studied the effects of restrictions related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic on the use of sexual healthcare and pre-exposure prophylaxis (PrEP) and on the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) in a prospective, open-label PrEP demonstration study (AMPrEP) in Amsterdam, the Netherlands. METHODS: We retrieved data from 2019 to 2020 for participants with one or more study visit in 2019 (n = 305) and from two COVID-19 questionnaires (2020: n = 203; 2021: n = 160). Analyses were stratified for three periods of pandemic-related restrictions (first: 15 March 2020-15 June 2020; second: 16 June 2020-15 September 2020; third: 16 September 2020-31 December 2020 or 1 April 2021 for the COVID-19 questionnaire). Endpoints included returning for care during the pandemic, PrEP use (increased/unchanged vs. deceased/stopped, relative to 2019), and any STI/HIV. We modelled determinants of care and PrEP use via multivariable logistic regression and STI incidence using piecewise Poisson regression, comparing the 2020 and 2019 periods. RESULTS: Of the 305 MSM included in the analysis, 72.8% returned for care during the pandemic, and this was significantly more likely among daily (vs. event-driven) PrEP users (p < 0.001). Increased/unchanged PrEP use ranged from 55.2% to 58.1% across the three pandemic periods and was more likely among those reporting chemsex in the first (p = 0.001) and third (p = 0.020) periods and among those reporting an increased/unchanged number of sex partners during the second period (p = 0.010). STI incidence was significantly lower in 2020 than in 2019 during the first period (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.28-0.68) and not significantly different during the second (IRR 1.38; 95% CI 0.95-2.00) and third (IRR 1.42; 95% CI 0.86-2.33) periods. No HIV was diagnosed. CONCLUSION: COVID-19-related restrictions coincided with reduced care and PrEP use. Changes in STI incidence suggest delayed diagnoses. Ways to ensure continued access to sexual healthcare during restrictions are needed.
目的：我们研究了与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2；2019 年冠状病毒病[COVID-19]）大流行相关的限制措施对性保健和暴露前预防（PrEP）的使用以及对男男性行为者（MSM）性传播感染（STI）发病率的影响，这是在荷兰阿姆斯特丹进行的一项前瞻性、开放标签 PrEP 示范研究（AMPrEP）中。
方法：我们检索了 2019 年至 2020 年的数据，包括 2019 年有一次或多次研究访问的参与者（n=305）和两份 COVID-19 问卷的数据（2020 年：n=203；2021 年：n=160）。分析按与大流行相关的限制措施的三个时期进行分层（第一期：2020 年 3 月 15 日至 6 月 15 日；第二期：2020 年 6 月 16 日至 9 月 15 日；第三期：2020 年 9 月 16 日至 2020 年 12 月 31 日或 2021 年 4 月 1 日的 COVID-19 问卷）。终点包括在大流行期间返回护理、PrEP 使用（与 2019 年相比增加/不变与死亡/停止相比）和任何 STI/HIV。我们通过多变量逻辑回归模型和分段泊松回归模型分析了护理和 PrEP 使用的决定因素以及 STI 发病率，将 2020 年和 2019 年进行了比较。
结果：在纳入分析的 305 名 MSM 中，有 72.8%在大流行期间返回护理，与每日（而非事件驱动）PrEP 使用者相比，这一比例显著更高（p<0.001）。在三个大流行期间，PrEP 使用增加/不变的比例范围为 55.2%至 58.1%，在报告化学性行为的第一期（p=0.001）和第三期（p=0.020）以及报告第二期性伴侣数量增加/不变的参与者中更常见（p=0.010）。与 2019 年相比，2020 年第一期 STI 发病率显著降低（发病率比 [IRR] 0.43；95%置信区间 [CI] 0.28-0.68），第二期（IRR 1.38；95% CI 0.95-2.00）和第三期（IRR 1.42；95% CI 0.86-2.33）差异无统计学意义。未诊断出 HIV。
结论：与 COVID-19 相关的限制措施与护理和 PrEP 使用减少同时发生。STI 发病率的变化表明诊断延迟。需要采取措施确保在限制期间继续获得性保健。
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