Abstract
AimsWe aim to estimate the number of HIV pre-exposure prophylaxis (PrEP) users among men having sex with men (MSM) in Germany from 2017 through 2020, and analyse if PrEP needs expressed in 2017 might have been met by the expansion of PrEP until 2020.Subject and methodsWe estimated the number of PrEP users by using drug prescription data and information on on-demand/intermittent PrEP use from online surveys to determine the proportion of on-demand/intermittent and daily PrEP use as well as the average number of PrEP pills used.The number of MSM in need of PrEP in 2017 was estimated based on four groups defined among respondents to a large online survey, combining respondents with PrEP use intention and respondents indicating substantial sexual risks. The size of each group was estimated based on self-selection biases. MSM with PrEP need in 2017 were compared with the estimated number of persons taking PrEP by June 2020.ResultsWe estimated a total of 15,600 to 21,600 PrEP users in Germany by the end of June 2020, corresponding to 40–55% of men with PrEP use intention in 2017. A correlation between the regional distribution of PrEP use intention in 11/2017 and actual PrEP use by 06/2020 suggested an unequal regional distribution of unsatisfied needs. The number of men with unmet PrEP needs ranged between 27,500 and 93,000 in 06/2020.ConclusionPrEP use in Germany has increased considerably between 10/2017 and 06/2020, but large regional inequalities persist. PrEP is not yet readily accessible, and there is a need to expand services and encourage uptake.
Highlights
HIV pre-exposure prophylaxis (PrEP) use started officially in Germany in 2016 when the European Medicines Agency (EMA) approved the use of tenofovir–emtricitabine for PrEP (European Medicines Agency 2016)
To estimate the absolute number of PrEP users, we took the data on prescribed monthly doses for daily PrEP use and multiplied this with a factor that results in the number of monthly PrEP users, based on assumptions about 1) the proportions of daily and on-demand/intermittent PrEP use, and 2) the number of on-demand/intermittent PrEP users based on a monthly supply of a daily PrEP dose
By the end of 2019, the number of drug prescriptions assumed to be used for PrEP and covered by statutory health insurance companies had increased to 10,176 monthly doses
Summary
HIV pre-exposure prophylaxis (PrEP) use started officially in Germany in 2016 when the European Medicines Agency (EMA) approved the use of tenofovir–emtricitabine for PrEP (European Medicines Agency 2016). With official approval of this two-drug combination for HIV PrEP, any physician in Germany could prescribe these drugs for PrEP use. . PrEP activists had discovered and promoted a loophole for accessing affordable generics from abroad that relied mainly on a regulation allowing to import generics from outside of the European Union (EU) to the United Kingdom (UK) for personal use. This allowed importing the drugs into the UK and forwarding them by mail to Germany without customs control.
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