ArticleSexually transmitted infections2024
Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: a PrEP-to-need ratio investigation.
Article in Sexually transmitted infections, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
11 citing papers in PubMed, 17 citations in OpenAlex.
- HIV PrEP use and unmet need among gay, bisexual and other men who have sex with men in London: An analysis of community cross-sectional surveys in England 2019-2022.HIV medicine · 2026Article
- Thinking beyond the tablet: Acceptability of different HIV-PrEP modalities among GBMSM and gender-diverse individuals having sex with men in the UK.International journal of STD & AIDS · 2026Article
- Prevalence and factors associated with use of prophylaxis for HIV and sexually transmitted infections among sexual health service attendees in England: findings from a cross-sectional observational study.BMJ public health · 2026Article
- Article
- Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need.Sexually transmitted infections · 2025Article
- Maintain the gains: methods to evaluate the sustainability and scalability of HIV-related prevention, care, and treatment programs.Current opinion in HIV and AIDS · 2025Review
- Findings from the 'Ask Me About PrEP' HIV Pre-Exposure Prophylaxis Awareness Programme in England.Journal of evaluation in clinical practice · 2025Article
- Co-designing interventions with multiple stakeholders to address barriers and promote equitable access to HIV Pre-Exposure Prophylaxis (PrEP) in Black women in England.BMC public health · 2025Article
- Racial disparities in HIV pre-exposure prophylaxis (PrEP) awareness and uptake among white, Black, and Indigenous men in Canada: Analysis of data from the I'm Ready national HIV self-testing study.Canadian journal of public health = Revue canadienne de sante publique · 2025Article
- New horizons in sexual health: exploring PrEP and HIV incidence in adolescents.Revista de saude publica · 2024Article
- Disparities in PrEP use and unmet need across PEPFAR-supported programs: doubling down on prevention to put people first and end AIDS as a public health threat by 2030.Frontiers in reproductive health · 2024Article
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesHIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. In England, NHS availability was limited to participants of the PrEP Impact Trial until late 2020. Some key populations at greater risk of HIV were under-represented in the trial suggesting inequities in trial PrEP access. We used the PrEP-to-need ratio (PnR; number of PrEP users divided by new HIV diagnoses) to investigate whether PrEP access improved following routine commissioning in October 2020 and identify populations most underserved by PrEP.
methodsAggregated numbers of people receiving ≥1 PrEP prescription and non-late new HIV diagnoses (epidemiological proxy for PrEP need) were taken from national surveillance data sets. We calculated the PnR across socio-demographics during Impact (October 2017 to February 2020; pre-COVID-19 pandemic) and post-commissioning PrEP era (2021) in England.
resultsPnR increased >11 fold, from 4.2 precommissioning to 48.9 in 2021, due to a fourfold reduction in non-late new HIV diagnoses and near threefold increase in PrEP users. PnR increased across genders, however, the men's PnR increased 12-fold (from 5.4 precommissioning to 63.9 postcommissioning) while the women's increased sevenfold (0.5 to 3.5). This increasing gender-based inequity was observed across age, ethnicity and region of residence: white men had the highest PnR, increasing >13 fold (7.1 to 96.0), while Black African women consistently had the lowest PnR, only increasing slightly (0.1 to 0.3) postcommissioning, suggesting they were the most underserved group. Precommissioning, the PnR was 78-fold higher among white men than Black women, increasing to 278-fold postcommissioning.
conclusionsDespite the overall increase in PrEP use, substantial PrEP Impact trial inequities widened postcommissioning in England, particularly across gender, ethnicity and region of residence. This study emphasises the need to guide HIV combination prevention based on equity metrics relative to the HIV epidemic. The PnR could support the optimisation of combination prevention to achieve zero new HIV infections in England by 2030.
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