Estimating the ‘PrEP Gap’: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019

Hayes, R; Schmidt, Axel J.; Pharris, Anastasia; Azad, Yusef; Brown, Alison E; Weatherburn, Peter; Hickson, Ford; Delpech, Valérie; Noori, Teymur

doi:10.2807/1560-7917.es.2019.24.41.1900598

Cited by 69 publications

(86 citation statements)

References 8 publications

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“…Although PrEP is highly effective for HIV prevention, PrEP availability and scale-up across Europe has been slow and uneven to date, and the ‘gap’ between self-reported use and expressed need is large across European countries [15]. Additionally, our survey highlights high demand for PrEP and a larger PrEP ‘gap’ than expected, with around one in five individuals in need of PrEP but unable or unsure of how to access publicly funded PrEP.…”

Section: Discussionmentioning

confidence: 90%

Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019

O’Halloran

Owen²,

Croxford

et al. 2019

Eurosurveillance

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The 2019 online pre-exposure prophylaxis (PrEP) user survey in the United Kingdom was conducted to assess HIV PrEP access, and user characteristics. One in five respondents continued experiencing difficulties accessing PrEP; users were almost exclusively gay or bisexual men at high risk of HIV. The majority obtained PrEP through health service clinics and rated PrEP positively. High STI rates were reported among users. Renal and sexual health checks are advised for those sourcing PrEP privately.

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Section: Discussionmentioning

confidence: 90%

Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019

O’Halloran

Owen²,

Croxford

et al. 2019

Eurosurveillance

Self Cite

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“…Multiple demonstration studies worldwide have shown the feasibility and acceptability of delivering PrEP to different key populations, such as men who have sex with men (MSM), transgender women (TGW), and adolescent girls and young women (AGYW) [6]. Considering this broad evidence base, the number of countries implementing PrEP has been increasing over the past few years [6][7][8]. By June 2018, a total of 19 high-income countries (HICs) and 21 low-and middle-income countries (LMICs) had adopted, or had a pending policy for, formal PrEP implementation [7].…”

Section: Introductionmentioning

confidence: 99%

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

Vanhamel

Rotsaert

Reyniers

et al. 2020

BMC Health Serv Res

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Background: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods: We conducted a scoping review using the five-step framework provided by Arksey and O'Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers' professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set. Results: This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings. Conclusions: A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.

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“…Although in 2016 the European Medicines Agency gave a positive opinion on PrEP use [7], in 2019 still only 14 European and Central Asian countries provided reimbursed PrEP [8]. The PrEP gap (the proportion of people not diagnosed with HIV infection who would be very likely to use PrEP if it were available) is largest in CEE [8]. As stated by the Euroguidelines in Central and Eastern Europe (ECEE) Network Group, although health care providers are ready to implement this strategy in daily practice, there are numerous political, technical and legal barriers which delay the implementation of PrEP in the region [9].…”

Section: Introductionmentioning

confidence: 99%

Where are we with pre‐exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group

et al. 2020

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Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. Methods The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). Results About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018

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Estimating the ‘PrEP Gap’: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019

Cited by 69 publications

References 8 publications

Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019

Current experiences of accessing and using HIV pre-exposure prophylaxis (PrEP) in the United Kingdom: a cross-sectional online survey, May to July 2019

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

Where are we with pre‐exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group

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