Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Arch Sex Behav. 2024 Oct;53(9):3663-3672. doi: 10.1007/s10508-024-02922-5. Epub 2024 Aug 6.
Human immunodeficiency virus pre-exposure prophylaxis (PrEP) is considered as an effective protection against a human immunodeficiency virus (HIV) infection. However, it is still unclear, how PrEP use is associated with the incidence of sexually transmitted infections (STI) other than HIV. PrEP became reimbursable in Germany from September 1, 2019 for persons with statutory health insurance (SHI). With the EvE-PrEP study, the Federal Ministry of Health commissioned the evaluation of the effects of the new reimbursement situation in Germany. In the presented module of the EvE-PrEP study, routine data from three large German SHI funds were analyzed in anonymized form for the period January 1, 2019 to March 31, 2020. Data were analyzed regarding: Characteristics and adherence of PrEP users, treatment success of PrEP, and changes in STI incidence rates before and since PrEP use. The cooperating SHI funds collectively covered about 52% of the overall population in Germany in 2019. A total of 7102 persons with PrEP use were included into the analysis. These were predominantly male (99%), on average 37.4 years old and a high proportion of persons lived in large cities. The average quotient of PrEP daily defined doses and assumed days on PrEP was 87%. The average STI rates normalized per 100 person-years at individual level pre PrEP did not statistically significant differ compared to since PrEP (chlamydia: 17.5 vs. 17.6, gonococcal infection: 29.1 vs. 30.7, and syphilis: 14.6 vs.13.6). A large data set was used to evaluate the introduction of PrEP as a SHI benefit in Germany. A potentially suspected increase in bacterial STI incidence rates was not found. A rather high average adherence rate was observed. The very high proportion of men and people from the largest German cities among PrEP users is striking. These results could indicate barriers to PrEP access for people at risk of HIV, especially if they are women or people living in less urban areas.
人免疫缺陷病毒暴露前预防（PrEP）被认为是预防人类免疫缺陷病毒（HIV）感染的有效措施。然而，PrEP 的使用与除 HIV 以外的性传播感染（STI）的发生率之间的关联仍不清楚。自 2019 年 9 月 1 日起，德国将 PrEP 纳入法定健康保险（SHI）的报销范围。联邦卫生部委托 EvE-PrEP 研究评估德国新报销情况的效果。在 EvE-PrEP 研究的介绍模块中，以匿名形式分析了三个德国大型 SHI 基金在 2019 年 1 月 1 日至 2020 年 3 月 31 日期间的常规数据。数据分析了以下内容：PrEP 用户的特征和依从性、PrEP 的治疗效果以及 PrEP 使用前后 STI 发病率的变化。合作的 SHI 基金在 2019 年共覆盖了德国总人口的约 52%。共有 7102 名 PrEP 用户纳入分析。这些人主要为男性（99%），平均年龄为 37.4 岁，其中很大一部分人居住在大城市。PrEP 每日规定剂量与假设 PrEP 天数的平均比值为 87%。个体水平 PrEP 前每 100 人年标准化的平均 STI 率与 PrEP 后相比无统计学显著差异（衣原体：17.5 比 17.6，淋球菌感染：29.1 比 30.7，梅毒：14.6 比 13.6）。使用大型数据集评估了 PrEP 作为德国 SHI 福利的引入。未发现细菌 STI 发病率潜在可疑增加。观察到较高的平均依从率。PrEP 用户中男性和来自德国最大城市的人的比例非常高，这令人瞩目。这些结果可能表明 HIV 高危人群获得 PrEP 的障碍，尤其是女性或居住在非城市地区的人群。
