Estimating the HIV PrEP care continuum among gay, bisexual and other men who have sex with men in Amsterdam and the Netherlands, 2023

Objective: – HIV-pre-exposure prophylaxis (PrEP) implementation can be examined by the PrEP care continuum that defines steps toward effective HIV prevention. We examined the PrEP continuum among gay, bisexual and other men who have sex with men (GBMSM) in the Netherlands and in Amsterdam. Design: – Cross-sectional study combining multiple data sources. Methods: – The following steps of the PrEP care continuum were estimated for 2023: 1) GBMSM not living with HIV, 2) accessed sexual health services, 3) PrEP-eligible, 4) PrEP-intention, 5) current PrEP use, and 6) PrEP continuation. The number of GBMSM progressing through each step were estimated and percentages were calculated using the nominator of the previous step. Results: – An estimated 746, 061 (Uncertainty Interval (UI) 634, 503-856, 079) GBMSM were not living with HIV in the Netherlands. Of those, 44, 911 (6%, UI 5-7%) accessed sexual health services, of whom 34, 895 (78%, UI 71–86%) were PrEP-eligible. We estimate that 22, 002 (63%, UI 49–78%) of those had intention to use PrEP. Of those with PrEP-intention, 12, 341 (56%, UI 47–69%) currently used PrEP and 10, 097 (82%) of those continued PrEP. Of those who accessed sexual health services, 23% continued PrEP in the Netherlands, and 30% in Amsterdam. Conclusions: – When having accessed sexual health services, retention in the PrEP care continuum was high, except for ‘PrEP-intention’ and ‘current use’ on the national level. To optimize PrEP implementation, targeted interventions to close this gap and annual monitoring of the PrEP care continuum using standardized resources are needed.