Early Rollout Research Articles

Engagement in Care, Awareness, and Interest in Long-Acting Injectable Anti-Retroviral Therapy

Long Acting Injectable (LAI) therapy to treat HIV is an alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients’ awareness and interest in this novel therapy. We administered an electronic survey to patients attending an urban HIV clinic in the US South. Eligible participants were 18 + years old with a most recent HIV-1 viral load < 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked about current treatment, engagement in care, and knowledge of LAI. Between January-April 2023, 480 patients were screened; 319 were eligible, and 155 (49%) completed the survey. The majority (119, 77%) were aware of, and 87 (56%) were interested in LAI. In regression analysis, only age was associated with interest in LAI (OR 0.95, 95% CI 0.92,0.99). Among proposed benefits of injectables, ease of travel without pills, lack of daily pill-taking, and fewer medication interactions were most appealing. Among proposed concerns with injectables, higher cost and insurance coverage of the new medicine were most worrisome. A large majority of people with HIV (PWH) are aware of the newest treatment available, and just over half of our sample expressed interest in LAI. Older age was associated with lower interest in LAI. LAI is appealing for its convenience, privacy, and avoidance of drug interactions, while the increased costs associated with LAI need to be addressed.

Assessing New York City's COVID-19 Vaccine Rollout Strategy: A Case for Risk-Informed Distribution.

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors.Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45-64years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.

1609. Engagement in Care, Awareness, and Interest in Long-Acting Injectable Anti-Retroviral Therapy

Abstract Background Long Acting Injectable (LAI) therapy to treat HIV is now a viable alternative to daily oral medications. The success of early roll-out of LAI to eligible patients requires a better understanding of patients’ awareness and interest in this novel therapy. Methods We administered an electronic survey to patients attending an urban HIV clinic in the US South (Duke University). Eligible participants were 18+ years old with a most recent HIV-1 viral load &amp;lt; 200 copies/ml, without any evidence of genotypic resistance to LAI components or chronic hepatitis B. Survey recipients were asked questions on their current treatment, their awareness and interest in LAI, and were asked to rate common benefits and concerns associated with LAI. After probing awareness of LAI, patients were provided further details on LAI for consideration for the rest of the survey. The survey also included the 3-item Brief Index of Engagement in HIV Care, a patient-reported measure of engagement in HIV care that has predicted future retention in care outcomes. Results Between January-April 2023, 480 patients were screened; 319 were found to be eligible, and 159 (50%) completed the survey. 73% were male; 44% Black, 7% Latinx; mean age was 49. The majority (119, 76%) were aware of injectable treatments, and 87 (56%) were interested in LAI. Among proposed benefits of injectables, ease of travel without pills, fewer medication interactions, and lack of daily pill-taking were most appealing. Among proposed concerns with injectables, out of pocket cost and insurance coverage of the new medicine were most worrisome. Black patients were more likely to be interested in LAI, and interested patients tended to be younger, single, and more recently diagnosed with HIV. Overall, patients surveyed were highly engaged in care (Mean 4.5/5, SD: 0.5)., but engagement was not predictive of awareness or interest in LAI. This table summarizes and compares the key patient characteristics between the patients who rated themselves interested or not interested in LAI Conclusion As we roll out LAI in real world settings, it will be helpful to characterize which patients are most interested in order to optimize uptake and benefit. Ease of travel without pills, not having to remember daily doses, and fewer medication interactions were the most appealing reasons, while concerns about both insurance coverage and out of pocket cost will need to be addressed. Disclosures Mehri McKellar, MD, Gilead Sciences, Inc: Grant/Research Support

Partisanship, attribution and approval in a public health shock

Political scientists have long agreed that partisanship can bias how voters evaluate government performance and attribute responsibility. However, less is known about how – and to what extent – these biases work across different types of voters, or how they respond to positive or non-partisan policy outcomes. In this research note we address these questions, focusing on how voters respond to a positive, non-partisan public health shock: the successful early rollout of Covid-19 vaccinations in England. Through a pre-registered information experiment embedded in the British Election Study (N > 6000), we test how voters respond to claims that the quasi-independent National Health Service, rather than the government, deserved credit for the success of the programme. On average, subjects do attribute less responsibility to government, but this has no downstream effect on general approval. Exploratory heterogeneity analyses suggest that government and opposition supporters, as well as historic swing voters, respond homogeneously to our intervention. Our findings are not fully explained by rational or selective frameworks of responsibility attribution, and add nuance to existing experimental work on the political effects of the pandemic.

Implementation of PM-JAY in India: a qualitative study exploring the role of competency, organizational and leadership drivers shaping early roll-out of publicly funded health insurance in three Indian states

BackgroundThe Pradhan Mantri Jan Arogya Yojana (PM-JAY), a publicly funded health insurance scheme, was launched in India in September 2018 to provide financial access to health services for poor Indians. PM-JAY design enables state-level program adaptations to facilitate implementation in a decentralized health implementation space. This study examines the competency, organizational, and leadership approaches affecting PM-JAY implementation in three contextually different Indian states.MethodsWe used a framework on implementation drivers (competency, organizational, and leadership) to understand factors facilitating or hampering implementation experiences in three PM-JAY models: third-party administrator in Uttar Pradesh, insurance in Chhattisgarh, and hybrid in Tamil Nadu. We adopted a qualitative exploratory approach and conducted 92 interviews with national, state, district, and hospital stakeholders involved in program design and implementation in Delhi, three state capitals, and two anonymized districts in each state, between February and April 2019. We used a deductive approach to content analysis and interpreted coded material to identify linkages between organizational features, drivers, and contextual elements affecting implementation.Results and conclusionPM-JAY guideline flexibilities enabled implementation in very different states through state-adapted implementation models. These models utilized contextually relevant adaptations for staff and facility competencies and organizational and facilitative administration, which had considerable scope for improvement in terms of recruitment, competency development, programmatic implementation support, and rationalizing the joint needs of the program and implementers. Adaptations also created structural barriers in staff interactions and challenged implicit power asymmetries and organizational culture, indicating a need for aligning staff hierarchies and incentive structures. At the same time, specific adaptations such as decentralizing staff selection and task shifting (all models); sharing of claims processing between the insurer and state agency (insurance and hybrid model); and using stringent empanelment, accreditation, monitoring, and benchmarking criteria for performance assessment, and reserving secondary care benefit packages for public hospitals (both in the hybrid model) contributed to successful implementation. Contextual elements such as institutional memory of previous schemes and underlying state capacities influenced all aspects of implementation, including leadership styles and autonomy. These variations make comparisons across models difficult, yet highlight constraints and opportunities for cross-learning and optimizing implementation to achieve universal health coverage in decentralized contexts.

Decisions about adopting novel COVID-19 vaccines among White adults in a rural state, USA: A qualitative study.

Many people, especially in rural areas of the United States, choose not to receive novel COVID-19 vaccinations despite public health recommendations. Understanding how people describe decisions to get vaccinated or not may help to address hesitancy. We conducted semistructured interviews with 17 rural inhabitants of Maine, a sparsely populated state in the northeastern US, about COVID-19 vaccine decisions during the early rollout (March-May 2021). We used the framework method to compare responses, including between vaccine Adopters and Non-adopters. Adopters framed COVID-19 as unequivocally dangerous, if not personally, then to other people. Describing their COVID concerns, Adopters emphasized disease morbidities. By contrast, Non-adopters never mentioned morbidities, referencing instead mortality risk, which they perceived as minimal. Instead of risks associated with the disease, Non-adopters emphasized risks associated with vaccination. Uncertainty about the vaccine development process, augmented by social media, bolstered concerns about the long-term unknown risks of vaccines. Vaccine Adopters ultimately described trusting the process, while Non-adopters expressed distrust. Many respondents framed their COVID vaccination decision by comparing the risks between the disease and the vaccine. Associating morbidity risks with COVID-19 diminishes the relevance of vaccine risks, whereas focusing on low perceived mortality risks heightens their relevance. Results could inform efforts to address COVID-19 vaccine hesitancy in the rural US and elsewhere. Members of Maine rural communities were involved throughout the study. Leaders of community health groups provided feedback on the study design, were actively involved in recruitment, and reviewed findings after analysis. All data produced and used in this study were co-constructed through the participation of community members with lived experience.

Generating scholarly content with ChatGPT: ethical challenges for medical publishing.

Generating scholarly content with ChatGPT: ethical challenges for medical publishing.

Hospitalization among vaccines for SARS-CoV-2 breakthrough infection after dose sparing strategies in Libya: A cohort study.

SARS-CoV-2 infection is widely spread over people, from youth to the elderly. Vaccination against SARS-CoV-2 is an essential preventive measure to help end the SARS-CoV-2 pandemic. A multi-center retrospective cohort study was conducted on patients in Libya who had received single-dose licensed three different types of vaccines (Oxford/AstraZeneca, CoronaVac, or Sputnik-V) and were admitted to healthcare centers with SARS-CoV-2 infection from 30th April to 15th July 2021. In this study, the number of people infected with SARS-COV-2 and the mortality rate from daily reports issued by the National Centers for Disease Control of Libya (NCDC) were collected. Approximately 445000 single doses of the SARS-COV-2 vaccine were administered in Libya from April to July 2021. In corresponding, 39996 people were infected during this period. It has been found that among the people who did not receive any vaccine, the number of patients infected by SARS-COV-2 and admitted to the healthcare centers, and died was (N = 3176 patients (7.94%), and 266 (7.10%) respectively). Compared to 43 (0.10%) of those admitted to healthcare centers who had taken a single dose from one of the licensed vaccines, of which 8 patients (0.02%) died during this period. The documented 23 patients were those who admitted to healthcare centers and got vaccinated with the CoronaVac (Sinovac) vaccine. Fourteen patients received Oxford/AstraZeneca. Only 2 patients received the Sputnik V vaccine. Of the breakthrough infection cases reviewed, 8 patients died. No deaths due to breakthrough infection among Sputnik V vaccinated patients were reported. In conclusion, a single dose of the three different types of the vaccine has significantly reduced virus interpersonal transmission and also showed a decrease in the mortality rate until the tenth week in Libya. The present study demonstrates the extent of the remarkable success of the early rollout of the coronavirus national vaccination campaign.

The Baby Box scheme in Scotland:A study of public attitudes and social value.

The Scottish Government introduced a free Baby Box scheme for all new parents in 2017, modelled on the Finnish scheme, to give every baby 'an equal start in life'. There is little evidence that it results in better health outcomes, but there has been limited research into different perspectives and discourses on such schemes. Four focus groups were conducted with 21 parents in North-East Scotland. Recordings were transcribed verbatim, anonymized and analysed thematically with NVivo 12 software. Our thematic analysis was both inductive and deductive-remaining open to themes identified by participants themselves but also informed by the social policy literature on universalism and social cohesion. Across all the focus groups, we found a high degree of positivity about the principle of the Baby Box scheme, and for the most part the practical value of the contents. This was remarkably consistent across different communities and backgrounds. There was little evidence of the strongly polarized views present in media reporting. Parents seemed considerably less focused than the media on safety and health outcomes, and more focused on practical, material and social impacts. They reported little in the way of feeling patronized or monitored by the government. Our findings have important implications for future economic evaluations of the baby box. Such evaluations should broaden the valuation space beyond health outcomes to allow for the value of feelings of inclusion, solidarity and being part of a community. This small project was designed in response to parent views already collected in the early roll-out of the Baby Box scheme in Scotland, about their priorities and responses to the scheme. Additional views were sought on the topic guide for the focus groups, and local community groups advised us on recruitment and the best timing and location for the focus groups to be held. The focus groups themselves were conducted as research, but with the intent of ensuring parent views featured more prominently in a debate that has been largely dominated by clinical and public health perspectives.

Multisectoral, Combination HIV Prevention for Adolescent Girls and Young Women: A Qualitative Study of the DREAMS Implementation Trajectory in Zambia.

To identify solutions to the implementation challenges with the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women) Partnership in Zambia, this study examines the rollout and evolution of the DREAMS Partnership's implementation. In September-October 2018, implementing partner (IP) staff (n=15) and adolescent girls and young women (AGYW) participating in DREAMS programming (n=32) completed in-depth interviews exploring early rollout and scale-up of DREAMS, experiences with program participation, and shifting service delivery approaches in response to emerging implementation challenges. Inductive and deductive thematic analysis of 47 interviews uncovered salient service delivery facilitators and barriers in the first 2 years of DREAMS implementation, which were subsequently mapped onto the following domains: reach, effectiveness, adoption, implementation, and maintenance. Key implementation successes identified by IP staff included using standardized recruitment and risk assessment tools across IP organizations, using a mentor model for delivering program content to AGYW, and offering centralized service delivery at venues accessible to AGYW. Implementation challenges identified early in the DREAMS Partnership's lifecycle were rectified through adaptive service delivery strategies. Monthly in-person coordination meetings were established to resolve IP staff jurisdictional disputes over recruitment and target setting. To address high participant attrition, IP staff adopted a cohort approach to sequentially recruit AGYW who enrolled together and provided social support to one another to sustain involvement in DREAMS programming. Prominent barriers to implementation fidelity included challenges recruiting the highest-risk AGYW (e.g., those out of school), limited resources to incentivize participation by young women, and inadequate planning to facilitate absorption of individual DREAMS interventions by the public sector upon project conclusion. Delivering multisectoral HIV prevention programs like DREAMS with fidelity requires a robust implementation infrastructure (e.g., adaptable workplans and harmonized record management systems), early coordination between IP organizations, and sustained financial commitments from donors.

Racial concentration and dynamics of COVID-19 vaccination in the United States

This article considers how county-level concentrations of Asians, Blacks, Hispanics, and Whites are associated with COVID-19 vaccination differently. I argue that racially specific mechanisms-differential concentrations of social vulnerability and political ideology by race-are likely to create diverse associations between racial concentration and COVID-19 vaccination not only across racial groups but also within racial groups over time from early rollout to the time after COVID-19 vaccines became widely available. I test this argument by drawing on data from multiple sources that include county-level information on COVID-19 vaccination rates, racial population make-ups, and measures of political ideology and community vulnerability. Results show that the association between racial concentration and COVID-19 vaccination changes substantially across and within racial groups over time. Counties with higher percent of Asians and percent of Whites have higher vaccination rates at earlier time intervals whereas counties with higher percent of Latinos and percent of Blacks show lower vaccination rates. This trend flips at later dates for percent of Blacks, percent of Latinos, and percent of Whites. Results from multilevel regression models and mediation analysis controlling for vaccine hesitancy show that social vulnerability and political ideology are the underlying factors and their differential associations with diverse racial concentrations help create the racially specific and time-varying patterns.

Hesitancy and reactogenicity to mRNA-based COVID-19 vaccines-Early experience with vaccine rollout in a multi-site healthcare system.

BackgroundHesitancy and incomplete vaccination against coronavirus disease 2019 (COVID-19) remains an obstacle to achieving herd immunity. Because of fear of vaccine reactions, patients with medical and allergic co-morbidities express heightened hesitancy. Limited information is available to guide these patients. We sought to identify factors associated with mRNA-based COVID-19 vaccines hesitancy and reactogenicity.MethodsWe surveyed employees of a multi-site health system in central Pennsylvania who were offered the COVID-19 vaccine (N = 18,740) inquiring about their experience with the Moderna and Pfizer-BioNTech mRNA-based vaccines. The survey was administered online using the REDCap platform. We used multivariable regression analysis to determine whether a particular factor(s) (e.g., demographics, selected co-morbid allergic and medical conditions, vaccine brand, and prior COVID-19) were associated with vaccine reactogenicity including the occurrence and severity of local and systemic reactions. We also explored factors and reasons associated with vaccine hesitancy.ResultsOf the 5709 who completed the survey (response rate, 30.4%), 369 (6.5%) did not receive the vaccine. Black race and allergy to other vaccines were associated with vaccine hesitancy. Reaction intensity following the first vaccine dose and allergic co-morbidities were associated with incomplete vaccination. Older individuals (>60 years) experienced less reactogenicity. Females had higher odds of local and systemic reactions and reported more severe reactions. Asians reported more severe reactions. As compared to Pfizer-BioNTech, the Moderna vaccine was associated with higher odds of vaccine reactions of higher severity. Prior COVID-19 resulted in more severe reactions following the first dose, but less severe reactions following the second dose.ConclusionsTargeted campaigns to enhance vaccination acceptance should focus on Black individuals, females, and those with allergic co-morbidities. Prior COVID-19 caused more severe reactions after the first but not the second vaccine dose. Moderna vaccine caused more vaccine reactions. Lessons learned from the early rollout of COVID-19 vaccine may serve to inform future novel vaccine experiences.

EE179 Key Drivers of the Economically Justifiable Price of the COVID-19 Vaccine in England

EE179 Key Drivers of the Economically Justifiable Price of the COVID-19 Vaccine in England

Using sero-epidemiology to monitor disparities in vaccination and infection with SARS-CoV-2

As SARS-CoV-2 continues to spread and vaccines are rolled-out, the “double burden” of disparities in exposure and vaccination intersect to determine patterns of infection, immunity, and mortality. Serology provides a unique opportunity to measure prior infection and vaccination simultaneously. Leveraging algorithmically-selected residual sera from two hospital networks in the city of San Francisco, cross-sectional samples from 1,014 individuals from February 4–17, 2021 were each tested on two assays (Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 and Roche Elecsys Anti-SARS-CoV-2), capturing the first year of the epidemic and early roll-out of vaccination. We estimated, using Bayesian estimation of infection and vaccination, that infection risk of Hispanic/Latinx residents was five times greater than of White residents aged 18–64 (95% Credible Interval (CrI): 3.2–10.3), and that White residents over 65 were twice as likely to be vaccinated as Black/African American residents (95% CrI: 1.1–4.6). We found that socioeconomically-deprived zipcodes had higher infection probabilities and lower vaccination coverage than wealthier zipcodes. While vaccination has created a ‘light at the end of the tunnel’ for this pandemic, ongoing challenges in achieving and maintaining equity must also be considered.

Adverse events following immunization against COVID-19 among healthcare workers: An observational study in Haryana, India

Background: COVID-19 is a novel coronavirus leading to rampant spread and pandemic ongoing since March 2020. Scientists/researchers and professionals from health-care related disciplines started tremendous efforts for early rollout of the vaccine and vaccines started coming out by the end of the year 2020. India rolled out two vaccines developed in India itself on January 6 and started the world biggest vaccination drive for nearly 2 lakh frontline healthcare and sanitary workers, on January 16, 2021. Because COVID-19 vaccines are novel vaccines, information on risk of rare serious vaccine reactions are limited. Aims and Objectives: The aim of the study was to assess the adverse drug reactions following immunization with Covishield Vaccine. Materials and Methods: The present study is an observational follow-up study to asses any adverse events following immunization (AEFI) occurrence within 7 days of vaccination among all eligible participants who were vaccinated under the field practice area of Rural Health Training Center, Al-Falah School of Medical Sciences and Research Center, Faridabad (Haryana). Results: The overall incidence of any AEFI within 7 days was found to be 136/1000 vaccinations for the first dose. Out of total 97 recipients reported with adverse events, 76.3% had AEFI within 24 h with fever as the most common symptom reported. The incidence of AEFI’s was found to be associated with gender (P&lt;0.02) and age group (P&lt;0.05) and occupation (P&lt;0.05). Conclusion: Most of the adverse events were short-lived and observed in the first 24 hours of vaccination. Incidence decreased in subsequent days and no serious AEFI was reported.

Demonstration Project for Ground Tire Rubber and Post-Consumer Recycled Plastic-Modified Asphalt Mixtures

Research has demonstrated that asphalt pavements can be a strategic destination for some of the major streams of waste materials around the globe, such as scrap tires and plastics. Ground tire rubber (GTR) from scrap tires has been used in asphalt pavements since the 1960s but has yet to approach its full potential in relation to market adoption. The heightened restrictions imposed by China in relation to waste stream contamination in 2018 have catalyzed research on incorporating post-consumer recycled (PCR) plastics into asphalt pavements. A field demonstration project was carried out in Columbia, MO to evaluate modern recycled plastic and GTR additives in an asphalt pavement overlay. The demonstration focused on dry-process modification, which requires minimal alterations to an existing asphalt plant and allows a higher amount of recyclates to be utilized. The project was also designed to assist in the Missouri Department of Transportation’s early roll-out of balanced mix design asphalt design and quality assurance specifications. The results of the study indicated the viability of dry-process GTR and PCR plastic additives used with neat (unmodified) asphalt binder as an alternative to binders modified with virgin polymers, chemical treatments, or both, in a wet process. The results of the study also suggest the viability of hybrid wet polymer-modified binder with dry-process PCR plastic as a greener alternative to binders modified with virgin polymers, chemical treatments, or both. Future studies will be needed to examine additional PCR plastic streams, especially mixed polymer streams.

Confidence and Hesitancy During the Early Roll-out of COVID-19 Vaccines Among Black, Hispanic, and Undocumented Immigrant Communities: a Review

Black and Hispanic Americans have been hardest hit with COVID-19 infections, hospitalizations, and deaths, yet during the first several months of vaccine roll-out they had the lowest level of vaccine uptake. Primarily, our research on vaccine hesitancy focused on skepticism around the vaccine itself and its roll-out. Our search strategy used PUBMED and Google with a prescribed set of definitions and search terms for two reasons: there were limited peer-reviewed studies during early period of roll-out and real-time perspectives were crucially needed. Literature searches occurred in April 2021and covered September 2020-April 2021. Analyses included expert opinion, survey results and qualitative summaries. Overall, for the general U.S. population, there was considerable hesitancy initially that remained high during the early roll-out. The general population expressed concerns over the speed of vaccine development (“warp speed”), confidence in the competence of government being involved in the development of vaccines and general mistrust of government. Among Black and Hispanic Americans, hesitancy was further expressed as mistrust in the medical establishment that was related to past and current medical mistreatment. Undocumented immigrants worried about access to insurance and possible deportation. These results on confidence in the vaccine early during vaccine roll-out suggest diverse reasons that influence a person’s decision to vaccinate or not. Additional barriers to vaccine uptake include complacency and access. To ensure health equity, particularly to address disparities in morbidity and mortality, vaccine hesitancy needs to be acknowledged and addressed as COVID-19 vaccine roll-out continues, and these observations calls for conscious planning to address these issues early with future health crises.

Addressing Disparities for Intersectional BIPOC Communities: The Hood Medicine Initiative Case Study.

Addressing Disparities for Intersectional BIPOC Communities: The Hood Medicine Initiative Case Study.

Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome

Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome

Charging infrastructure roll-out strategies for large scale introduction of electric vehicles in urban areas: An agent-based simulation study

• A data-driven agent-based model compared charging station roll-out strategies. • Increasing size, due to return to scale effects result in utilisation efficiency. • Policy makers face a trade-off between providing accessibility & convenience. • Mixed roll-out strategies (Level 2, hubs, Fast) satisfies EV driver demand best. On the eve of the large-scale introduction of electric vehicles, policy makers have to decide on how to organise a significant growth in charging infrastructure to meet demand. There is uncertainty about which charging deployment tactic to follow. The main issue is how many of charging stations, of which type, should be installed and where. Early roll-out has been successful in many places, but knowledge on how to plan a large-scale charging network in urban areas is missing. Little is known about return to scale effects, reciprocal effects of charger availability on sales, and the impact of fast charging or more clustered charging hubs on charging preferences of EV owners. This paper explores the effects of various roll-out strategies for charging infrastructure that facilitate the large-scale introduction of EVs, using agent-based simulation. In contrast to previously proposed models, our model is rooted in empirically observed charging patterns from EVs instead of travel patterns of fossil fuelled cars. In addition, the simulation incorporates different user types (inhabitants, visitors, taxis and shared vehicles) to model the diversity of charging behaviours in an urban environment. Different scenarios are explored along the lines of the type of charging infrastructure (level 2, clustered level 2, fast charging) and the intensity of rollout (EV to charging point ratio). The simulation predicts both the success rate of charging attempts and the additional discomfort when searching for a charging station. Results suggest that return to scale and reciprocal effects in charging infrastructure are considerable, resulting in a lower EV to charging station ratio on the longer term.