Transforming HIV prevention Early adoption of PrEP in Amsterdam

The Amsterdam PrEP demonstration project (AMPrEP) studied oral pre-exposure prophylaxis (PrEP) use among 367 men who have sex with men and transgender women from 2015 to 2020. Participants could opt for daily or event-driven PrEP and switch regimens during quarterly visits. This thesis specifically evaluated adherence, renal safety, sexual behaviour, and STI rates over time.
Adherence studies include a randomised trial aiming to improve adherence using a mobile app with visual feedback on PrEP use and sexual behaviour. App feedback did not significantly decrease poor adherence, but did boost excellent adherence. We also identified factors linked to good adherence to PrEP: older age and higher numbers of condomless anal sex with casual partners, while longer PrEP use led to slightly reduced adherence, highlighting the need for continued counselling.
Kidney function was monitored over a median of 54 months, showing minor declines consistent with aging, but we did see a slower kidney function decline among event-driven users compared with daily users. All in all, we can recommend reduced monitoring for users at low risk of kidney dysfunction.
Long term sexual behaviour and STI outcomes show that, despite high STI incidence, there was no increase in STIs, and STI rates of chlamydia and gonorrhea slightly decreased among daily PrEP users. We also analysed regimen switching and discontinuation. Daily PrEP was preferred, and reasons for switching varied, often linked to age and sexual behaviour.
In conclusion, this thesis provides support for wider, low-threshold access to PrEP forms and prioritisation of underserved groups. Community involvement in research and practice is essential for achieving zero new HIV infections.