Dynamics of HIV PrEP use and coverage during and after COVID-19 in Germany.

Autor: Schmidt D; Department of Infectious Disease Epidemiology, Robert-Koch Institute, Berlin, Germany. SchmidtD@rki.de., Duport Y; Project Groups, Robert-Koch Institute, Berlin, Germany., Kollan C; Department of Infectious Disease Epidemiology, Robert-Koch Institute, Berlin, Germany., Marcus U; Department of Infectious Disease Epidemiology, Robert-Koch Institute, Berlin, Germany., Iannuzzi S; Project Groups, Robert-Koch Institute, Berlin, Germany., von Kleist M; Project Groups, Robert-Koch Institute, Berlin, Germany. vkleist@zedat.fu-berlin.de.; Department of Mathematics and Computer Science, Freie Universität Berlin, Berlin, Germany. vkleist@zedat.fu-berlin.de.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2024 Jun 25; Vol. 24 (1), pp. 1691. Date of Electronic Publication: 2024 Jun 25.
DOI: 10.1186/s12889-024-19198-y
Abstrakt: Background: Pre-exposure prophylaxis (PrEP) with oral emtricitabine/tenofovir disoproxil (FTC/TDF) proved highly efficient in preventing HIV. Since 09/2019, FTC/TDF-PrEP is covered by health insurances in Germany, if prescribed by licensed specialists. However, methods to longitudinally monitor progress in PrEP implementation in Germany are lacking.
Methods: Utilizing anonymous FTC/TDF prescription data from 2017-2021, we developed a mathematical model to disentangle HIV-treatment from PrEP prescriptions, as well as to translate PrEP prescriptions into number of PrEP users. We used the model to estimate past- and future PrEP uptake dynamics, to predict coverage of PrEP needs and to quantify the impact of COVID-19 on PrEP uptake on a national and regional level.
Results: We identified significant (p<0.01) decelerating effects of the first- and second COVID-19-lockdown on PrEP uptake in 04/2020 and 12/2020. We estimated 26,159 (CI: 25,751-26,571) PrEP users by 12/2021, corresponding to 33% PrEP coverage of people in need. We projected 64,794 (CI: 62,956-66,557) PrEP users by 12/2030, corresponding to 81% PrEP coverage. We identified profound regional differences, with high PrEP coverage and uptake in metropoles and low coverage in more rural regions.
Conclusions: Our approach presents a comprehensive solution to monitor and forecast PrEP implementation from anonymous data and highlighted that the COVID-19 pandemic significantly decelerated PrEP uptake in Germany. Moreover, slow PrEP uptake in rural areas indicate that structural barriers in PrEP care, education or information exist that may hamper the goal of ending the AIDS epidemic by 2030.
(© 2024. The Author(s).)
Databáze: MEDLINE
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