Koole Jeffrey C D, Bedert Maarten R D, de la Court Feline, Bais Irene, Wit Ferdinand, Stalenhoef Janneke, Mudrikova Tania, Pogany Katalin, van Benthem Birgit, Prins Maria, Davidovich Udi, van der Valk Marc
Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
Amsterdam University Medical Centers, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands.
PLoS One. 2025 Jan 6;20(1):e0310621. doi: 10.1371/journal.pone.0310621. eCollection 2025.
Oral pre-exposure prophylaxis (PrEP) prevents Human Immunodeficiency Virus (HIV) acquisition. In the Netherlands, PrEP is accessible through the national PrEP program (NPP) or general practitioners (GP). Still, some men who have sex with men (MSM) entering HIV care indicated having PrEP experience prior to diagnosis. We aimed to identify barriers and missed opportunities in PrEP uptake, care and use among MSM with HIV and previous PrEP experience.
Between March 2022-March 2023, we conducted semi-structured in-depth interviews on PrEP among MSM diagnosed with HIV from 2019 onwards with previous PrEP experience. Interviewees were recruited through their HIV treatment centers and social media.
Of the 11 included MSM, most reported significant PrEP-uptake delay because of the limited NPP capacity and high threshold of accessing PrEP from GPs (e.g. stigma, lack of sexual health expertise). Additional uptake or use barriers included anticipated/experienced side-effects, burden of daily pill-taking or event-driven regimen complexity, the latter leading to PrEP discontinuation. Missed opportunities in counseling on adherence and safer sex alternatives after discontinuation were reported. Most interviewees considered informal PrEP unsuitable.
PrEP uptake delay played a crucial role in context of HIV infection among MSM with HIV and previous PrEP experience. HIV diagnoses at or shortly after PrEP initiation emphasize the importance of ensuring rapid and timely PrEP access. Uptake barriers at GPs, stigma on sexuality, lack of expertise, and missed care opportunities need to be addressed. Early detection of PrEP protocol/user-mismatch and counseling on safer sex alternatives after discontinuation are pivotal for sustainable HIV prevention.
口服暴露前预防（PrEP）可预防人类免疫缺陷病毒（HIV）感染。在荷兰，可通过国家PrEP项目（NPP）或全科医生（GP）获得PrEP。然而，一些开始接受HIV治疗的男男性行为者（MSM）表示在确诊前有过PrEP使用经历。我们旨在确定有HIV感染史且有过PrEP使用经历的MSM在PrEP获取、护理和使用方面的障碍及错失的机会。
在2022年3月至2023年3月期间，我们对2019年起确诊为HIV且有过PrEP使用经历的MSM就PrEP进行了半结构化深入访谈。通过他们的HIV治疗中心和社交媒体招募受访者。
在纳入的11名MSM中，大多数人报告称，由于NPP能力有限以及从全科医生处获取PrEP的门槛较高（如耻辱感、缺乏性健康专业知识），PrEP的获取出现了显著延迟。其他获取或使用障碍包括预期/经历的副作用、每日服药负担或事件驱动方案的复杂性，后者导致停止使用PrEP。报告称在停止使用PrEP后，在坚持用药和更安全性行为替代方案咨询方面存在错失的机会。大多数受访者认为非正规的PrEP不合适。
在有HIV感染史且有过PrEP使用经历的MSM中，PrEP获取延迟在HIV感染情况中起关键作用。在开始PrEP时或之后不久被诊断出HIV强调了确保快速及时获取PrEP的重要性。全科医生处的获取障碍、性取向方面的耻辱感、缺乏专业知识以及错失的护理机会都需要得到解决。早期发现PrEP方案/使用者不匹配情况以及在停止使用PrEP后就更安全性行为替代方案进行咨询对于可持续的HIV预防至关重要。
