ECDC releases operational guidance on HIV pre-exposure prophylaxis in the EU/EEA and the UK
Since 2015, there has been a steady decline in HIV diagnoses in the EU/EEA; however, the 90-90-90 target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) has not been met consistently across EU/EEA countries. A further and substantial reduction in HIV incidence is required if Europe is to meet the target to end the epidemic of AIDS by 2030 as defined in the Sustainable Development Goals.
Reaching these targets requires a sustained focus on HIV prevention, including new interventions and approaches. New approaches include the implementation of pre-exposure prophylaxis (PrEP) and clear minimum standards for standardised delivery and monitoring of PrEP across the EU/EEA.
ECDC guidance on implementation, standards, and monitoring of PrEP
The European Centre for Disease Prevention and Control (ECDC) has developed an operational guidance to support countries in their efforts and to harmonise the overall approach taken to PrEP implementation in the region. This guidance provides practical recommendations to inform the development and implementation of PrEP programmes at national and sub-national levels throughout the EU/EEA.
The guidance lays out key considerations for PrEP implementation and provides an overview of key markers of readiness to deliver larger-scale PrEP programmes. It also provides guidance on how to establish support from senior and community stakeholders and prioritise PrEP within national health agendas.
Core principles of effective PrEP programmes
The guidance is structured around 10 core principles of effective PrEP programmes, categorised as being relevant for preparatory (before a programme exists), new (under 24 months) and established (24 months and above) phases of PrEP implementation:
- Early and ongoing stakeholder engagement
- Implementation within a stigma-free environment
- Population wide access, based on need
- PrEP embedded in combination STI and HIV prevention, and sexual health programmes
- Proactive approach to raising PrEP awareness and demand creation
- Compliance with clinical and public health guidelines
- Use of standardised eligibility criteria to assess need
- Linkage into care
- Continuation of PrEP
- Monitoring and evaluation
PrEP for HIV is the use of antiretroviral medication, taken to prevent the acquisition of HIV infection.
In 2015, ECDC recommended that EU/EEA Members States should consider integrating PrEP into their existing HIV prevention package for those most at-risk of HIV infection, starting with men who have sex with men. This was followed by the WHO recommendations that PrEP should be offered as an additional prevention option to all people at substantial risk of HIV infection as part of combination prevention approaches.
To support Member States in developing and delivering PrEP programmes, the following documents are available as accompaniments to the guidance:
- The Case for PrEP – considerations for HIV PrEP programmes. ECDC has developed a PESTLE framework to support implementation of PrEP in EU/EEA Member States.
- Country case studies from Belgium, Croatia, Czechia, England, Finland, France, Germany, Greece, Ireland, Italy, Malta, Netherlands, Poland, Scotland, Spain, Sweden and Switzerland, outlining different service delivery models used, the advantages and limitations of these and reflections from the clinical, public health and community representatives responsible for the programme.
- An example of a standardised monitoring tool, providing key monitoring indicators developed through three rounds of consultation with public health, epidemiology, clinical academic and health planning experts from Ireland and the UK.