ECDC Evidence Brief: Pre-exposure prophylaxis for HIV prevention in Europe

technical report
Publication series: Monitoring Implementation of the Dublin Declaration
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European Centre for Disease Prevention and Control. Evidence brief: Pre-exposure prophylaxis for HIV prevention in Europe. Stockholm: ECDC; 2016.

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​This ECDC evidence brief assesses data from a collaborative ECDC and Hornet Gay Social Network rapid survey of a non-representative sample of men who have sex with men in Europe about pre-exposure prophylaxis use for HIV prevention. This is part of the monitoring of the implementation of the Dublin Declaration on the partnership to fight HIV/AIDS in Europe and Central Asia in 2016.

Executive summary

​Pre-exposure prophylaxis (PrEP) is the use of an antiretroviral medication by people who are HIV-negative with the aim to prevent HIV infection. So far, France is the only country in Europe that provides PrEP through its public health services. A new ECDC Evidence Brief summarises many of the key issues across Europe regarding implementation of PrEP and provides some options for action. It draws on country data reported to ECDC for Dublin Declaration monitoring in 2016.​​​

The efficacy of PrEP has been clearly demonstrated in a number of randomised controlled trials in recent years. Based on this evidence, ECDC suggested in 2015 that EU Member States should give consideration to integrating PrEP into their existing comprehensive HIV prevention package for those most at risk of HIV infection, starting with men who have sex with men. 

Men who have sex with men are the only population in the EU/EEA where the number of new HIV infections continues to increase: in 2014, sex between men accounted for 42% of all newly diagnosed cases of HIV. In this scenario, PrEP could be used as an additional prevention option within a combination prevention approach. This could provide an opportunity to reduce transmission of the virus, and could reverse the increase in new infections among this and other populations who are most at risk.

Reported key barrier for PrEP: cost

Use of an antiretroviral medication for preventive use (PrEP) has been approved in the European Union this year, but currently France is the only European country that makes pre-exposure prophylaxis available through its public health system. Most countries cite the current cost of drugs as a key barrier to provision of PrEP by public health services.

The ECDC Evidence Brief gives an overview on the current status of PrEP availability and projects across European countries. It also outlines some possible options for action starting with the development of better data on the populations and the number of people who could benefit from PrEP, and touches on establishing of eligibility criteria to maximise feasibility and its public health benefit.