Authors
P. Vinti (1), E. Caruso (1), V. Calvino (2), L. Cosmaro (3), M. Farinella (4), N. Frattini (5), G. Giupponi (6), F. Leserri (7), S. Mattioli (8), P. Meli (9), A. Moznich (10), S. Patrucco (11), I. Pennini (12), F. Schlösser (13), M. Stizioli (14), D. Calzavara (1)
Affiliation
(1) Milano Check Point ETS, Milano, Italy, (2) ANLAIDS Nazionale ETS, Roma, Italy, (3) Fondazione LILA Milano ETS, Milano, Italy, (4) CCO Mario Mieli APS, Roma, Italy, (5) ASA ODV, Milano, Italy, (6) LILA Nazionale ONLUS, Como, Italy, (7) Plus Roma APS, Roma, Italy, (8) Plus APS, Bologna, Italy, (9) CICA ETS, Milano, Italy, (10) NPS Italia APS, Milano, Italy, (11) Arcobaleno AIDS ODV, Torino, Italy, (12) Arcigay APS, Bologna, Italy, (13) Nadir ETS, Roma, Italy, (14) PrEP in Italia, Brescia, Italy
ABSTRACT
Background: High PrEP coverage among people at substantial risk for HIV is essential to end AIDS as a public health threat by 2030. WHO encourages countries to simplify and demedicalise PrEP initiations, and to implement differentiated service delivery approaches. WHO has been updating its guidance on PrEP based on emerging implementation evidence, which may result in gaps in national guidelines incorporating those updates. In Italy, PrEP reimbursement within the national health system was approved in 2023, together with guidance for its delivery. Both the national PrEP guidelines and the AIDS strategic plan were last updated in 2017.
Methods: A policy analysis was conducted to assess inclusion of the WHO recommendations on PrEP adopted since 2017 into the current Italian national PrEP guidance. A list of recommended practices was extracted from the latest WHO PrEP guidance and their inclusion into the Italian guidance was checked.
Results: 24 practices recommended by WHO since 2017 were identified and grouped into three thematic areas. The policy analysis showed that only 9 of the 24 WHO-recommended practices are included in the Italian guidance (Table 1). Contrary to WHO recommendations, disclosure of personal details on sexual behaviour or drug use is required to access PrEP and only men who have sex with men are eligible for event-driven PrEP. PrEP is reimbursed within the national health system only when distributed at HIV clinics and can only be prescribed by HIV specialists. Community-based delivery is not linked nor integrated with the national health system. For those not eligible for event-driven PrEP, the Italian PrEP guidance recommends stopping PrEP 4 weeks after the last possible exposure, instead of 7 days as recommended by WHO.
Conclusions: The findings highlight a number of barriers to PrEP access in Italy. PrEP delivery is still highly medicalised and centralised in HIV clinics, making it undesirable for some members of key populations, and inaccessible to members of marginalised and underserved groups already facing barriers with the national health system. It is concerning that a number of evidence-based recommendations that do not entail additional costs and increase the acceptability of PrEP, especially for cisgender women and transgender people, were not considered. An evidence-based simplification of prescription requirements and clinical monitoring would allow same-day PrEP prescription and increase cost-effectiveness. The integration of community-based delivery and task-sharing with peer navigators and community health workers would increase PrEP accessibility, acceptability and cost-effectiveness. Not distributing PrEP outside of HIV clinics makes community-based PrEP services less convenient and less desirable. The current delivery model has to be reformed following WHO guidance, to make PrEP accessible to all those who can benefit from it and to increase coverage to a level that will make it effective population-wide.
Allegato: Poster presentato alla Conferenza
Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research
