Purpose: To describe the current state of the reimbursement and access of pre-exposure prophylaxis (PrEP) for people at high risk of HIV infection in European countries.
Method: A review of published literature, as well as desktop research of websites of European national governments, advocacy groups and HIV-related associations on PrEP reimbursement and availability was conducted.
Results: In 2016, the European Medicines Agency approved once-daily oral tenofovir disoproxil and emtricitabine (TDF/FTC) as PrEP in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults and adolescents at high-risk. A total of 7 European countries (Belgium, France, Germany, Norway, Portugal, Scotland, Sweden) currently reimburse PrEP through their national health systems. PrEP is available free of charge in the Netherlands and England through implementation/demonstration trials with a limit on participation, and in Wales and Northern Ireland through pilot projects. In other countries, PrEP can be purchased out of pocket through some pharmacies, health clinics, and through the internet. France and England have the largest number of PrEP users (>10,000 each). In France, out of >626,000 men who have sex with men, 32,000 (~5%) are considered high-risk, and >10,100 (32% of high risk) were using PrEP as June 2018. PrEP users are constantly increasing as demonstrated by reports from France, Belgium, Scotland and England. Studies in London and Paris have attributed the reduction of new HIV diagnoses to the introduction of a HIV prevention strategy that includes PrEP.
Conclusion: PrEP reimbursement and access in European countries is increasing, but there are still several countries in Central and Eastern Europe that have no or very limited PrEP access. It is too early to determine the real PrEP impact in the at-risk population. Further investigation of PrEP use in real-world settings is needed to understand its true impact on HIV epidemiology.
