Transient Changes in Pre-Exposure Prophylaxis Use and Daily Sexual Behaviour after the Implementation of COVID-19 Restrictions Among Men Who Have Sex with Men (preprint)

Introduction: We assessed how the Dutch restrictions of 15-March-2020 affected sexual behaviour, pre-exposure prophylaxis (PrEP) and condom use among PrEP-users from the Amsterdam PrEP demonstration project. Methods: We used data on (1) PrEP use, (2) anal sex acts and (3) condom use, per partner type (steady [SP], known casual [KCP], unknown casual [UCP]), collected daily through a mobile application used between 1-December-2019 and 30-June-2020. We compared the period before versus after 15-March-2020 with respect to average proportion of days per week at which each endpoint was reported (multilevel logistic regression) and average proportion of anal sex acts covered by PrEP and/or condoms (bivariate probit regression). We evaluated whether the difference in sex acts were also observed before versus after the same date in the previous year. Findings: We included data from 136 MSM. After 15-March-2020, the proportion of days with anal sex increased with SP (OR=1·26;95%CI=1·10-1·44) and decreased with KCP (OR=0·73;95%CI=0·64-0·82) and UCP (OR=0·54;95%C=0·48-0·61), while these changes were not seen (SP/KCP) or less apparent (UCP) during the previous year. Shifts in partner types were most profound immediately after 15-March-2020, while returning to pre-restriction levels mid-May-2020. The proportion of days with PrEP use decreased from 74% before to 58% after 15-March-2020 (p<0·001). After 15-March-2020, PrEP coverage of sex acts decreased with UCP (β=-0·36;95%CI=-0·72-0·00), but not with SP and KCP. Condom use during sex acts decreased with KCP (β=-0·36;95%CI=-0·67-to-0· 04) and UCP (β=-0·24;95%CI=-0·46-to-0·03), but not with SP. Interpretation: MSM decreased sex acts with casual partners and increased sex acts with SP, but changes were transient. Decreases in sex with casual partners paralleled decreases in PrEP use. However, condom use during sex with casual partners decreased, indicating the importance of continued sexual health services, including STI screening and PrEP care, during COVID-19 restrictions. Trial Registration: Netherlands Trial Registry, number NL5302 Funding: ZonMw, RIVM, GGD, Gilead Sciences, H-TEAM. Declaration of Interests: The study drug was donated by Gilead Sciences. EH obtained advisory board fees from Gilead Sciences, which were paid to her institute. UD obtained unrestricted research grants and speaker’s fees from Gilead Sciences, which were paid to his institution. HdV obtained a research grant from Medigene and advisory board and speaker fees from Gilead Sciences, Medigene, Abbvie, Janssen- Cilag and Willpharma, all of which were paid to his institution. MP obtained unrestricted research grants and speaker fees from Gilead Sciences, Roche, Abbvie and MSD, all of which were paid to her institution. All other authors declare no conflicts of interests. Ethics Approval Statement: The study was approved by the ethics board of the Amsterdam University Medical Centres, location Academic Medical Center (Amsterdam, the Netherlands; NL49504.018.14).