Wang Haoyi, Adriaque Lozano Alejandro, Kolstee Johann, Zimmermann Hanne Ml, Tosh Jonathan, Schroeder Melanie, Appiah Ama, Jonas Kai J
Viroscience department, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands.
Euro Surveill. 2025 Aug;30(34). doi: 10.2807/1560-7917.ES.2025.30.34.2500122.
BACKGROUNDPre-exposure prophylaxis (PrEP) provision routes across Europe differ notably between governmental and non-governmental pathways. The introduction of long-acting (LA)-PrEP may further diversify provision dynamics.AIMWe investigated disparities in PrEP access and whether access pathways determine oral PrEP use patterns and LA-PrEP intention among PrEP-experienced men who have sex with men (MSM).METHODSUsing data from 7,505 PrEP-experienced MSM from a cross-sectional survey (PROTECT; 20 European countries, October 2023-April 2024), we used latent class analysis (LCA) to identify MSM's latent socioeconomic positions (SEPs), and logistic regression to compare the likelihood of accessing governmental/non-governmental pathways, and compare oral PrEP adherence, discontinuation and LA-PrEP intention between governmental/non-governmental pathways.RESULTSMost MSM accessed PrEP via governmental pathways (n = 6,671; 88.9%), 11.1% (n = 834) used non-governmental pathways. The LCA identified three groups: employed MSM with more advantaged SEPs, younger MSM with less advantaged SEPs, and older MSM with more advantaged SEPs. Compared with the first group, younger MSM with less advantaged SEPs were significantly more likely to access PrEP via non-governmental pathways (aOR = 1.27; 95% confidence interval (CI): 1.04-1.55). Accessing PrEP via non-governmental pathways was associated with suboptimal adherence (aOR = 1.28; 95% CI: 1.03-1.58), discontinuation (aOR = 3.55; 95% CI: 2.99-4.21), but also higher LA-PrEP intention (aOR = 1.28; 95% CI: 1.06-1.56).CONCLUSIONSInequalities exist in PrEP access among MSM in Europe. While non-governmental pathways offer opportunities to engage MSM with less advantaged SEPs, oral PrEP use patterns via this pathway were not optimal. Tailored efforts should ensure that PrEP is accessible and affordable to enhance current use and prepare for future LA-PrEP modalities.
背景
在欧洲，暴露前预防（PrEP）的提供途径在政府和非政府渠道之间存在显著差异。长效（LA）-PrEP的引入可能会使提供动态进一步多样化。
目的
我们调查了有PrEP使用经验的男男性行为者（MSM）在PrEP获取方面的差异，以及获取途径是否决定口服PrEP的使用模式和对LA-PrEP的意向。
方法
利用一项横断面调查（PROTECT；20个欧洲国家，2023年10月至2024年4月）中7505名有PrEP使用经验的MSM的数据，我们使用潜在类别分析（LCA）来确定MSM的潜在社会经济地位（SEP），并使用逻辑回归来比较通过政府/非政府途径获取PrEP的可能性，以及比较政府/非政府途径之间口服PrEP的依从性、停药情况和对LA-PrEP的意向。
结果
大多数MSM通过政府途径获取PrEP（n = 6671；88.9%），11.1%（n = 834）使用非政府途径。LCA确定了三组：社会经济地位更优越的就业MSM、社会经济地位较不优越的年轻MSM以及社会经济地位更优越的年长MSM。与第一组相比，社会经济地位较不优越的年轻MSM通过非政府途径获取PrEP的可能性显著更高（调整后比值比[aOR]=1.27；95%置信区间[CI]：1.04 - 1.55）。通过非政府途径获取PrEP与依从性欠佳（aOR = 1.28；95% CI：1.03 - 1.58）、停药（aOR = 3.55；95% CI：2.99 - 4.21）相关，但对LA-PrEP的意向也更高（aOR = 1.28；95% CI：1.06 - 1.56）。
结论
欧洲MSM在PrEP获取方面存在不平等。虽然非政府途径为社会经济地位较不优越的MSM提供了参与机会，但通过该途径的口服PrEP使用模式并不理想。应采取有针对性的措施，确保PrEP可及且价格合理，以增加当前的使用并为未来的LA-PrEP模式做好准备。
