PrEP in Europe : where are we?
The picture of PrEP access in Europe is highly diverse and rapidly changing. The rising number of new infections in different populations across the region demands a fresh HIV prevention approach that includes the focussed and appropriate use of PrEP. This talk will cover various national programmes and other ongoing PrEP projects; estimated numbers of people on PrEP and gaps in these data; costing and payment options; and the rise of buyers’ clubs and other PrEP activism.
The various stumbling blocks to PrEP, such as the possible rise of other sexually transmitted infections, the perceived competition for resources with HIV treatment and the concerns about augmentation of antiretroviral resistance will be addressed with the intention of encouraging discussion.
The risks associated with non-regulated PrEP use strengthens the call for the establishment of national programmes. There is a choice of PrEP medicines available that can help to reduce costs along with pointers towards best service delivery practice that can be taken from existing PrEP programmes.
Cost effectiveness of PrEP in Europe
Over the last two years, mathematical models and economic evaluations have demonstrated the cost-effectiveness of PrEP use in several countries across Europe, particularly for men who have sex with men (MSM) and injection drug users (IDUs). Key determinants of the cost-effectiveness of PrEP are 1) its selective use: prioritization to those people at highest risk of HIV, and 2) the cost of PrEP. In cases where the cost of PrEP was strongly reduced, PrEP was even shown to be cost-saving or, in other words, costs less to prevent one HIV infection than the lifetime healthcare costs of that infection.
This body of work has contributed, in part, to the approval and financial reimbursement of PrEP in several countries, and will continue to aid decision makers across Europe in deciding whether to provide and reimburse PrEP.