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Background <p>Long-acting pre-exposure prophylaxis (LA-PrEP) is approved in Europe with promising HIV prevention potential. Currently, no data are available that examine intention to use LA-PrEP intention when it is not fully covered by healthcare/insurance programs. We investigated how the affordability of LA-PrEP impacts the intention to use LA-PrEP by men who have sex with men (MSM) in six European countries.</p> Methods <p>We included 10,592 HIV-negative MSM from an online cross-sectional survey (PROTECT, October 2023–April 2024), with participants from France (n = 1965), Germany (n = 2268), Italy (n = 1707), Spain (n = 1985), the United Kingdom (n = 1218) and the Netherlands (n = 1449). We investigated the intention to use LA-PrEP if one showed interest under different levels of affordability. For those who showed intention to use LA-PrEP when out-of-pocket copayments were required, we explored their intention by different copayments (ranging from &lt; €50/month to €1000 + /month). We used multinomial regression to explore the impact of individual income on their intention to use LA-PrEP across different affordability/copayment scenarios.</p> Results <p>Of the included MSM, 59%-79% showed LA-PrEP interest in these six countries. Among them, a consistent decline in the LA-PrEP intention was observed as affordability decreased: from 44%(FR)–91%(NL) at high affordability to 10%(DE)–26%(NL) at low affordability. MSM with a high income showed significantly higher intention under medium and low affordability scenarios in all countries. Among those who showed intention with copayments, a strongly declining intention was observed and reached almost 0% when the copayment exceeded €250/month in all countries. MSM with high income showed significantly higher intention when copayment was under €250/month in all countries.</p> Conclusions <p>LA-PrEP would be welcomed in Europe if affordable. When LA-PrEP is not fully-covered, MSM with a high income may be the early adopters. However, LA-PrEP may not be affordable for those with a reason to use LA-PrEP once monthly copayments exceed €250, stressing the need for availability under insurance plans, or with limited copayments.</p>

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The unseen impact of affordability: copayment sensitivity for long-acting PrEP among MSM in six European Countries, October 2023–April 2024

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  • 发表日期：

    2025年12月5日

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  • Haoyi Wang,
  • Johann Kolstee,
  • Hanne M. L. Zimmermann,
  • Kai J. Jonas

摘要

Background

Long-acting pre-exposure prophylaxis (LA-PrEP) is approved in Europe with promising HIV prevention potential. Currently, no data are available that examine intention to use LA-PrEP intention when it is not fully covered by healthcare/insurance programs. We investigated how the affordability of LA-PrEP impacts the intention to use LA-PrEP by men who have sex with men (MSM) in six European countries.

Methods

We included 10,592 HIV-negative MSM from an online cross-sectional survey (PROTECT, October 2023–April 2024), with participants from France (n = 1965), Germany (n = 2268), Italy (n = 1707), Spain (n = 1985), the United Kingdom (n = 1218) and the Netherlands (n = 1449). We investigated the intention to use LA-PrEP if one showed interest under different levels of affordability. For those who showed intention to use LA-PrEP when out-of-pocket copayments were required, we explored their intention by different copayments (ranging from < €50/month to €1000 + /month). We used multinomial regression to explore the impact of individual income on their intention to use LA-PrEP across different affordability/copayment scenarios.

Results

Of the included MSM, 59%-79% showed LA-PrEP interest in these six countries. Among them, a consistent decline in the LA-PrEP intention was observed as affordability decreased: from 44%(FR)–91%(NL) at high affordability to 10%(DE)–26%(NL) at low affordability. MSM with a high income showed significantly higher intention under medium and low affordability scenarios in all countries. Among those who showed intention with copayments, a strongly declining intention was observed and reached almost 0% when the copayment exceeded €250/month in all countries. MSM with high income showed significantly higher intention when copayment was under €250/month in all countries.

Conclusions

LA-PrEP would be welcomed in Europe if affordable. When LA-PrEP is not fully-covered, MSM with a high income may be the early adopters. However, LA-PrEP may not be affordable for those with a reason to use LA-PrEP once monthly copayments exceed €250, stressing the need for availability under insurance plans, or with limited copayments.