SEXUAL HEALTHCARE USE, PrEP USE, and the INCIDENCE of STI among MSM during COVID-19

ABSTRACT

Background: This study explores the effects of COVID-19 restrictions on sexual healthcare use, pre-exposure prophylaxis (PrEP) use, and sexually transmitted infection (STI) incidence among men who have sex with men (MSM) participating in a PrEP demonstration project in Amsterdam, the Netherlands (AMPrEP). Methods: We retrieved data from 2019-2020 for AMPrEP participants with ≥1 study visit in 2019 (n=305), and two questionnaires on COVID-19 measures and sexual behaviour in 2020 and 2021 (n=203;n=160). Analyses were stratified for three periods of COVID-19 restrictions (first 15/3/2020-15/6/2020;second 16/6/2020-15/9/2020;third 16/9/2020-31/12/2020 or 1/4/2021 for COVID-19 questionnaire data). Evaluated endpoints included proportion returning for sexual healthcare during COVID-19, change in PrEP use (increased/unchanged vs. deceased/stopped;relative to 2019), and incidence of any STI (chlamydia, gonorrhoea, or syphilis;diagnosed at clinic/study visit) or HIV. We modelled determinants of care and PrEP use via multivariable logistic regression, and STI incidence using piecewise Poisson regression;comparing 2020 periods to those in 2019. Results: Of the 305 included in the analysis, 72.8% (n=222) of participants returned for care during COVID-19, among which 147, 190, and 148 visits took place during the first, second, and third period of COVID-19 restrictions, respectively. Daily (versus event-driven) PrEP use was significantly associated with returning for care across periods (p<0.001). Increased/unchanged PrEP use was reported by 55.2% (n=112), 58.1% (n=93), and 55.6% (n=89) during the first, second, and third periods, respectively. Increased/unchanged PrEP use was more likely among those reporting chemsex in the first (p=0.001) and third (p=0.020) periods, and those reporting increased/unchanged number of sex partners relative to 2019 during the second period (p=0.010). STI incidence was significantly lower in 2020 than 2019 during the first (IRR=0.43, 95%CI=0.28-0.68), yet seemed higher during the second (IRR=1.38, 95%CI=0.95-2.00) and third periods (IRR=1.42, 95%CI=0.86-2.33), albeit non-significantly (figure 1). No new HIV infections were diagnosed. Conclusion: COVID-19 restrictions coincided with reduced care and PrEP use. The significantly lower STI incidence during the first period of COVID-19 restrictions and subsequent increase suggests a delayed diagnosis effect. We need ways to ensure continued access to sexual healthcare during restrictions.