Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis
Abstract
:1. Introduction
Estimating PrEP Awareness, Intention and PrEP Uptake
2. Materials and Methods
2.1. Study Population and Study Design
2.2. Study Settings and Measures
2.3. Outcomes and Covariates
2.4. Data Analysis
2.4.1. Descriptive Analysis
2.4.2. Multi-Level Analysis
3. Results
3.1. Study Population Characteristics
3.2. Prevalence and Standardised Prevalence Ratio of PrEP Awareness, Intention and Uptake
3.3. Multi-Level Analysis
3.3.1. Between Region Variances
3.3.2. Random Intercept Model
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Randstad | ROC | Overall | |||
---|---|---|---|---|---|---|
N | % | N | % | N | % | |
Age * | 43 | 16–80 | 43 | 16–87 | 43 | 16–87 |
Education level | ||||||
High | 820 | 71.3 | 1224 | 58.8 | 2044 | 63.2 |
Median | 220 | 19.1 | 550 | 26.4 | 770 | 23.8 |
Low | 110 | 9.6 | 308 | 14.8 | 418 | 12.9 |
Employment status | ||||||
Employed | 908 | 79.2 | 1495 | 72.0 | 240 3 | 74.6 |
Retired | 62 | 5.4 | 133 | 6.4 | 195 | 6.1 |
Student | 94 | 8.2 | 225 | 10.8 | 319 | 9.9 |
Unemployed | 83 | 7.2 | 222 | 10.7 | 305 | 9.5 |
Financial coping | ||||||
(Really) comfortable | 814 | 70.8 | 1370 | 65.8 | 2184 | 67.6 |
Neutral | 238 | 20.7 | 541 | 26.0 | 269 | 8.3 |
(Really) struggling | 98 | 8.5 | 171 | 8.3 | 779 | 24.1 |
Sexual identity | ||||||
Gay | 1021 | 88.8 | 1685 | 80.9 | 2706 | 83.7 |
Bisexual | 83 | 7.2 | 300 | 14.4 | 383 | 11.9 |
Straight or other | 46 | 4.0 | 97 | 4.7 | 143 | 4.4 |
Disclosure of sexual orientation (outness) | ||||||
All or almost all | 862 | 75.0 | 1362 | 65.4 | 2224 | 68.8 |
More than half | 136 | 11.8 | 214 | 10.3 | 350 | 10.8 |
Few or less than half | 145 | 12.6 | 485 | 23.3 | 630 | 19.5 |
None | 7 | 0.6 | 21 | 1.0 | 28 | 0.9 |
Having anal sex with another man recency | ||||||
Within 12 months | 958 | 83.3 | 1674 | 80.4 | 2632 | 81.4 |
Never or more than 12 months | 192 | 16.7 | 408 | 19.6 | 600 | 18.6 |
Decision to have safe sex # | 5 | NA | 4 | NA | 4 | NA |
Decision to reject sex # | 4 | NA | 5 | NA | 4 | NA |
PrEP knowledge # | 2 | NA | 0 | NA | 0 | NA |
HIV knowledge # | 3 | NA | 3 | NA | 3 | NA |
PHQ−4 (Depression/anxiety level) # | 1 | NA | 1 | NA | 1 | NA |
CAGE−4 (Alcohol dependency) # | 1 | NA | 1 | NA | 1 | NA |
CAI with non-steady partner | ||||||
Yes | 379 | 33.0 | 633 | 30.4 | 1012 | 31.3 |
No | 771 | 67.0 | 1449 | 69.6 | 2220 | 68.7 |
CAI with steady partner | ||||||
Yes | 143 | 12.4 | 272 | 13.1 | 415 | 12.8 |
No | 1007 | 87.6 | 1810 | 86.9 | 2817 | 87.2 |
CAI with non-steady partner with diagnosed HIV | ||||||
Yes | 129 | 28.2 | 164 | 19.8 | 293 | 22.8 |
No | 329 | 71.8 | 665 | 80.2 | 994 | 77.2 |
Ever diagnosed with syphilis, gonorrhoea or chlamydia | ||||||
Ever | 692 | 60.2 | 1046 | 50.2 | 1738 | 53.8 |
Never | 458 | 39.8 | 1036 | 49.8 | 1494 | 46.2 |
Transactional sex recency | ||||||
Ever, within 12 months | 126 | 11.0 | 225 | 10.8 | 351 | 10.9 |
Ever, more than 12 months | 1012 | 88.0 | 1805 | 86.7 | 2817 | 87.1 |
Never | 12 | 1.0 | 52 | 2.5 | 64 | 2.0 |
Injecting drug use | ||||||
Ever | 59 | 5.1 | 110 | 5.3 | 169 | 5.2 |
Never | 1091 | 94.9 | 1972 | 94.7 | 3063 | 94.8 |
Chemsex recency # | 8 | NA | 8 | NA | 8 | NA |
Region | PrEP Uptake | PrEP Awareness | PrEP Intention | |||
---|---|---|---|---|---|---|
Prevalence (%, 95% CI) | SPR * | Prevalence (%, 95% CI) | SPR * | Prevalence (%, 95% CI) | SPR * | |
Randstad | 7.91 (6.49–9.62) | 1.41 | 90.84 (89.02–92.38) | 1.11 | 46.26 (43.4–49.15) | 1.02 |
ROC | 3.07 (2.41–3.91) | 0.71 | 78.08 (76.23–79.83) | 0.94 | 45.44 (43.31–47.58) | 0.94 |
Predictors | Final Model PrEP Uptake(AIC = 568.6) | ||
---|---|---|---|
aOR | 95% CI | p-Value | |
PrEP awareness | |||
No | Ref. | - | - |
Yes | 0.4 | 0.04–4.06 | 0.437 |
PrEP intention | |||
No | Ref. | - | - |
Yes | 4.46 | 1.95–10.20 | <0.001 |
Decision to have safe sex | 1.29 | 1.03–1.61 | 0.028 |
PrEP knowledge | 7.34 | 4.28–12.56 | <0.001 |
CAI with non-steady partner | |||
No | Ref. | - | - |
Yes | 2.3 | 1.11–4.77 | 0.024 |
CAI with non-steady partner with diagnosed HIV | |||
No | Ref. | - | - |
Yes | 1.97 | 1.26–3.10 | 0.003 |
Ever diagnosed with syphilis, gonorrhoea or chlamydia | |||
Never | Ref. | - | - |
Ever | 2.14 | 1.15–3.98 | 0.016 |
Transactional sex | |||
Ever within the previous 12 months | Ref. | - | - |
Ever but longer than 12 months | 0.52 | 0.29–0.96 | 0.036 |
Never | 0 | 0.00–Inf | 0.993 |
Injecting drug use | |||
Never | Ref. | - | - |
Ever | 2.28 | 1.20–4.34 | 0.012 |
Education | |||
High | Ref. | - | - |
Median | 1.24 | 0.76–2.03 | 0.392 |
Low | 0.4 | 0.17–0.92 | 0.03 |
Random effects | |||
σ2 | 3.29 | ||
τ00 | 0.15randstad | ||
ICC | 0.046 | ||
Marginal R2/Conditional R2 | 0.706/0.719 |
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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. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. Int. J. Environ. Res. Public Health 2022, 19, 8829. https://doi.org/10.3390/ijerph19148829
Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, Vermey K, van Bijnen A, Zuilhof W, Jonas KJ. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. International Journal of Environmental Research and Public Health. 2022; 19(14):8829. https://doi.org/10.3390/ijerph19148829
Chicago/Turabian StyleWang, Haoyi, Oladipupo Shobowale, Chantal den Daas, Eline Op de Coul, Bouko Bakker, Aryanti Radyowijati, Koenraad Vermey, Arjan van Bijnen, Wim Zuilhof, and Kai J. Jonas. 2022. "Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis" International Journal of Environmental Research and Public Health 19, no. 14: 8829. https://doi.org/10.3390/ijerph19148829