Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Haoyi Wang; Oladipupo Shobowale; Chantal den Daas; Eline Op de Coul; Bouko Bakker; Aryanti Radyowijati; Koenraad Vermey; Arjan van Bijnen; Wim Zuilhof; Kai J. Jonas

doi:10.3390/ijerph19148829

Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Haoyi Wang, Oladipupo Shobowale, Chantal den Daas, Eline Op de Coul, Bouko Bakker, Aryanti Radyowijati, Koenraad Vermey, Arjan van Bijnen, Wim Zuilhof, Kai J. Jonas

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

7 Downloads (Pure)

Abstract

PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

Original language	English
Article number	8829
Number of pages	13
Journal	International Journal of Environmental Research and Public Health
Volume	19
Issue number	14
DOIs	https://doi.org/10.3390/ijerph19148829
Publication status	Published - 20 Jul 2022

Bibliographical note

Acknowledgments
The EMIS-2017 was coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS core team @ Sigma Research (LSHTM): Axel J. Schmidt, Ford Hickson; David Reid, and Peter Weatherburn; in association with Ulrich Marcus and Susanne B. Schink @ RKI. We thank all our partners for being part of something huge. The following list acknowledges all partners in the EMIS by country. Individual names are mentioned if a freelancer was the main contact and/or translator or where input on the questionnaire development came from a person not formally representing an organisation. The order (if available) is: main NGO partner, other NGO partners, academic partners, governmental partners, individuals. Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). NL: Results in Health, Maastricht University, Amsterdam Pink Panel, Soa Aids Nederland, Rutgers, Wim Vanden Berghe, Marije Veenstra.

Keywords

HIV prevention
MSM
PrEP use/uptake
socio-spatial analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3390/ijerph19148829Licence: CC BY

Wang_et_al_Determinants_of_PrEP_International_Journal_of_Environmental_Research_and_Public_Health_vor
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/
Final published version, 339 KBLicence: CC BY

Cite this

Wang, H., Shobowale, O., den Daas, C., Op de Coul, E., Bakker, B., Radyowijati, A., Vermey, K., van Bijnen, A., Zuilhof, W., & Jonas, K. J. (2022). Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. International Journal of Environmental Research and Public Health, 19(14), Article 8829. https://doi.org/10.3390/ijerph19148829

@article{5155492ed4c04080abcbf871ceccfb54,

title = "Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis",

abstract = "PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called {"}Randstad{"}, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.",

keywords = "HIV prevention, MSM, PrEP use/uptake, socio-spatial analysis",

author = "Haoyi Wang and Oladipupo Shobowale and {den Daas}, Chantal and {Op de Coul}, Eline and Bouko Bakker and Aryanti Radyowijati and Koenraad Vermey and {van Bijnen}, Arjan and Wim Zuilhof and Jonas, {Kai J.}",

note = "Acknowledgments The EMIS-2017 was coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS core team @ Sigma Research (LSHTM): Axel J. Schmidt, Ford Hickson; David Reid, and Peter Weatherburn; in association with Ulrich Marcus and Susanne B. Schink @ RKI. We thank all our partners for being part of something huge. The following list acknowledges all partners in the EMIS by country. Individual names are mentioned if a freelancer was the main contact and/or translator or where input on the questionnaire development came from a person not formally representing an organisation. The order (if available) is: main NGO partner, other NGO partners, academic partners, governmental partners, individuals. Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). NL: Results in Health, Maastricht University, Amsterdam Pink Panel, Soa Aids Nederland, Rutgers, Wim Vanden Berghe, Marije Veenstra.",

year = "2022",

month = jul,

day = "20",

doi = "10.3390/ijerph19148829",

language = "English",

volume = "19",

journal = "International Journal of Environmental Research and Public Health",

issn = "1660-4601",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "14",

}

TY - JOUR

T1 - Determinants of PrEP Uptake, Intention and Awareness in the Netherlands

T2 - A Socio-Spatial Analysis

AU - Wang, Haoyi

AU - Shobowale, Oladipupo

AU - den Daas, Chantal

AU - Op de Coul, Eline

AU - Bakker, Bouko

AU - Radyowijati, Aryanti

AU - Vermey, Koenraad

AU - van Bijnen, Arjan

AU - Zuilhof, Wim

AU - Jonas, Kai J.

N1 - Acknowledgments The EMIS-2017 was coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS core team @ Sigma Research (LSHTM): Axel J. Schmidt, Ford Hickson; David Reid, and Peter Weatherburn; in association with Ulrich Marcus and Susanne B. Schink @ RKI. We thank all our partners for being part of something huge. The following list acknowledges all partners in the EMIS by country. Individual names are mentioned if a freelancer was the main contact and/or translator or where input on the questionnaire development came from a person not formally representing an organisation. The order (if available) is: main NGO partner, other NGO partners, academic partners, governmental partners, individuals. Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). NL: Results in Health, Maastricht University, Amsterdam Pink Panel, Soa Aids Nederland, Rutgers, Wim Vanden Berghe, Marije Veenstra.

PY - 2022/7/20

Y1 - 2022/7/20

N2 - PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

AB - PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

KW - HIV prevention

KW - MSM

KW - PrEP use/uptake

KW - socio-spatial analysis

UR - http://www.scopus.com/inward/record.url?scp=85135122408&partnerID=8YFLogxK

U2 - 10.3390/ijerph19148829

DO - 10.3390/ijerph19148829

M3 - Article

C2 - 35886681

AN - SCOPUS:85135122408

SN - 1660-4601

VL - 19

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

IS - 14

M1 - 8829

ER -

Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this