Abstract
Data on PrEP use in Germany is not collected systematically. We aim to estimate the number of PrEP users among men having sex with men (MSM) and describe PrEP use in Germany from 2017 through 2020. Moreover, we analyse whether PrEP needs expressed in 2017 could have been met by the expansion of PrEP until 2020.
We estimated the number of PrEP users using drug prescription data, information on on-demand/intermittent PrEP use from online surveys, and number of online profiles indicating PrEP use, based on varying assumptions about the proportion of on-demand/intermittent and daily PrEP users and on the average number of PrEP pills used. Factors associated with intention to use PrEP were identified by a multivariable logistic regression analysis among respondents to an online survey. We estimated the number of MSM in need for PrEP in 2017 based on four groups defined among the survey respondents, combining respondents intending to use PrEP and respondents indicating substantial sexual risks. We used data and assumptions on self-selection biases to estimate a range for the absolute size of these groups among gay men in Germany.
Depending on assumptions, we estimated a total of 15,600 to 21,600 PrEP users in Germany by the end of June 2020, which corresponds to between 40 and 55% of men with the intention to use PrEP in 2017. Distributions of PrEP users from different data sources and PrEP prescriptions by federal state in Germany were highly correlated, except for major deviations for Berlin with a higher proportion of prescriptions in Berlin compared to the proportion of survey participants using PrEP. A correlation between the regional distribution of intention to use PrEP in 11/2017 and actual PrEP use by 06/2020 suggested an unequal regional distribution of unsatisfied needs. The number of men with unmet PrEP needs ranged between 27,500 and 93,000 in 06/2020.
PrEP use in Germany has increased considerably between 10/2017 and 06/2020, but large regional inequalities persist. Results suggested that PrEP is not fully accessible and that there is a need to expand services and encourage demand.