Next step after PrEP: HIV prevention pathways among former PrEP users disengaged from care

To gain insight into HIV prevention pathways of individuals following pre-exposure prophylaxis (PrEP) care disengagement at the Center of Sexual Health in Amsterdam (CSHA), the Netherlands, to improve prevention services.

Cross-sectional study.

CSHA clients disengaged from PrEP care were asked to complete an online survey (January-April 2025). The survey included open-ended, closed-ended, and multiple-choice questions on PrEP care discontinuation reasons at CSHA, continuing PrEP care elsewhere and sexual behavior. This was complemented by routine CSHA data. Data was analyzed using descriptive statistics, thematic analysis, and multivariable Bayesian logistic regression to identify determinants of non-PrEP-use elsewhere.

Of the 734 people who disengaged from PrEP care, 273 (37.2%) responded to the questionnaire. Changes in sexual behavior to reduce the chance of HIV acquisition was the main reason for discontinuation (n = 117, 62.6% of those with available data). Among respondents who confirmed their PrEP discontinuation at CSHA and were not living with HIV (n = 247), 82 (33.2%) could still benefit from PrEP. Of those, 56 (68.3%) continued PrEP use elsewhere, leaving a PrEP need of 31.7% (n = 26); 11 (13.4%) did not use any HIV prevention strategy. People who were lost-to-follow-up (i.e., stopping without notification) and ≤35  years old had higher odds of non-PrEP-use elsewhere.

Most PrEP discontinuations reflected periods without an indication for PrEP. Nevertheless, a substantial proportion of individuals who could benefit from PrEP reported not using HIV prevention after disengagement from PrEP care at CSHA. Our results highlight a need to support these individuals for re-engagement in care to reduce chance of acquiring HIV.