4b - Optimising HIV pre-exposure prophylaxis eligibility in men who have sex with men in 10 European countries: a modelling study and cost-effectiveness analysis
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Background : Men who have sex with men (MSM) remain at high risk for HIV in Europe, with significant disparities in Pre-exposure Prophylaxis (PrEP) eligibility and accessibility. This study evaluates the impact of various PrEP eligibility criteria on HIV prevention and the cost-effectiveness of PrEP interventions across ten European countries.
Methods : We employed a network-based, dynamic, stochastic model to simulate HIV transmission within MSM populations, comparing different PrEP eligibility guidelines. The model integrated data on sexual behavior, PrEP adherence, and healthcare costs, projecting HIV incidence and the economic outcomes of PrEP policies over a 20-year period.
Results : The analysis demonstrated that PrEP policies in the US and Belgium were most effective in reducing HIV cases and deaths, attributed to higher PrEP coverage. The WHO policy was identified as the most cost-effective, achieving significant health outcomes with minimal coverage. Notably, except in low-prevalence settings, all PrEP policies substantially reduced HIV transmission. Economic evaluations indicated that PrEP interventions are generally cost-effective, with the WHO policy consistently offering the greatest economic benefit.
Conclusions The study underscores the importance of optimizing PrEP eligibility criteria and coverage to maximize HIV prevention efforts in Europe. High-coverage PrEP strategies, supported by comprehensive reimbursement policies, are crucial for enhancing PrEP accessibility and effectiveness. Our findings advocate for informed policy-making to leverage the full potential of PrEP in the global fight against HIV, albeit with consideration for the limitations of our modeling approach.