Background: Pre-exposure prophylaxis (PrEP) for HIV prevention was approved by the European Medical Agency in 2016, however, high costs prevented widespread use in Germany. We therefore implemented a novel distribution pathway by October 2017 that reduced monthly PrEP costs by 16fold.
Methods: Access to PrEP was linked to a monitoring system for prescriptions. Users were asked to participate in a questionnaire to understand motivation, PrEP intake frequencies, perceived HIV risk and recent STD diagnosis.
Results: Within a month prescriptions doubled from 514 to 1082. While an estimated minority of 10% had previously obtained PrEP from outside sources (e.g. online pharmacies), 98% had now switched to the new available system. Extrapolation of the current available data suggest an estimated PrEP use of ~2500 PrEP user/month within the first year in Germany. Interim-evaluation of 550 questionnaires from PrEP users demonstrated a homogenous population of well-educated men who have sex with men, median age 38 (range:18-71) and 83% of German descent. The overwhelming motivation to use PrEP was to compensate for HIV risk while having condomless anal intercourse. However, at start of PrEP implementation the majority perceived their own risk to acquire HIV as low to medium (81%), while only a subset (17%) considered themselves to be at risk for HIV infection. In contrast, 39% of the PrEP user had a diagnosis of gonorrhoea, syphilis or chlamydia in the 6 months before starting to use PrEP and 28% had condomless anal intercourse in the absence of other prevention methods. Those that had an STD within the last 6 months had a significant higher risk perception than those that did not (p=0.008; Fishers Exact). Analysis of the follow up questionnaire (n=56) revealed that 78% of the PrEP user indicated to have not missed any PrEP dose, while 20% indicated that they forgot to take at least 1 pill (avg. 1,25 pills ±1,25). Furthermore, 25% indicated to have been diagnosed with an STD since last visit.
Conclusions: Taken together, our data from PrEP implementation in Germany demonstrates a large uptake of the new prevention method in individuals, who wish to compensate for HIV risk while having condomless anal intercourse.