Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium.
Intermutualistisch Agentschap, Brussels, Belgium.
BMC Public Health. 2024 Aug 23;24(1):2296. doi: 10.1186/s12889-024-19691-4.
Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs.
Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use.
Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30-45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1-4.2) and 3.6 tests per person-year (95% CI 3.5-3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12-0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7-83.8).
The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users.
自 2017 年 6 月以来，比利时已为具有较高 HIV 感染风险的人群报销口服暴露前预防 (PrEP) 的费用。为了为国家 PrEP 计划提供信息，我们描述了 PrEP 使用者的社会人口统计学特征、PrEP 配药情况、HIV 和性传播感染 (淋病、衣原体和梅毒) 的检测情况以及 HIV 和性传播感染的发病率。
对 2017 年 6 月至 2019 年 12 月期间至少开具一次 PrEP 处方的所有个人的常规社会健康保险索赔数据进行分析。使用年龄调整的逻辑回归，我们检查了社会人口统计学特征与在 PrEP 使用的前六个月仅开具一次 PrEP 之间的关联。
共有 4559 人开具了 PrEP。几乎所有 PrEP 使用者均为男性（99.2%，4522/4559），中位年龄为 37 岁（IQR 30-45）。少数人有权获得增加的医疗保健津贴（11.4%，514/4559）。18%（657/3636）在 PrEP 使用的前六个月仅开具一次 PrEP。与同龄人相比，年龄小于 25 岁、失业、有权获得增加的医疗保健津贴且在 2019 年 1 月至 2019 年 6 月期间开始 PrEP 的 PrEP 用户在开始后更有可能没有配药。细菌性性传播感染和 HIV 的检测率分别为每人每年 4.2 次（95%CI 4.1-4.2）和每人每年 3.6 次（95%CI 3.5-3.6）。在研究期间，有 12 人被确定发生了血清转换，导致 HIV 发病率为 0.21/100 人年（95%CI 0.12-0.36）。细菌性性传播感染的发病率为 81.2/100 人年（95%CI 78.7-83.8）。
该研究强调了 PrEP 持续存在的挑战以及接受 PrEP 的个体中细菌性性传播感染的高发病率。需要针对具有持续 HIV 风险的个体提供有针对性的预防支持，以优化 PrEP 的效果。PrEP 护理中需要整合性传播感染检测和预防干预措施，以减轻 PrEP 用户的性传播感染获取和传播。
