Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

Bruno Sepodes; João Rocha; Jorge Batista; Maria-Eduardo Figueira; František Dráfi; Carla Torre

doi:10.3389/fmed.2021.722247

Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

Front Med (Lausanne). 2021 Aug 25:8:722247. doi: 10.3389/fmed.2021.722247. eCollection 2021.

Authors

Bruno Sepodes^{1

2}, João Rocha^{1

2}, Jorge Batista³, Maria-Eduardo Figueira^{2

4}, František Dráfi⁵, Carla Torre^{1

2}

Affiliations

¹ Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.
² Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal.
³ Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal.
⁴ Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmaceutical Sciences and Medicines, Lisbon, Portugal.
⁵ Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine of the Slovak Academy of Sciences, Bratislava, Slovakia.

Abstract

Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).

Keywords: Europe; HIV infection; PrEP; acquired immunodeficiency syndrome; aids; implementation; men who have sex with men; pre-exposure prophylaxis.

Publication types

Review