Abstract
OBJECTIVES: In England, HIV pre-exposure prophylaxis (PrEP) was routinely commissioned at sexual health services from 2020. We compared PrEP use and unmet need among gay, bisexual and other men who have sex with men (GBMSM) in London before (2019) and during (2022) routinely commissioned PrEP and the factors associated with its use. METHODS: Cross-sectional, self-administered surveys were conducted in London commercial venues in 2019 (n = 1408) and 2022/2023 (n = 1090). Anonymous questionnaires collected data on socio-demographic characteristics, sexual behaviours, service engagement and outcomes. PrEP need was defined as condomless anal sex (CAS) in the last 3 months or with HIV-positive/unknown status partners not on HIV treatment in the last year. Multivariable logistic regressions examined factors associated with PrEP use. RESULTS: Among HIV-negative/unknown GBMSM, current PrEP use more than doubled (19.9% (245/1233) in 2019 to 44.2% (360/814) in 2022 (p < 0.001)), representing 2.7-fold higher odds of PrEP use among GBMSM with identified PrEP need pre- to post-commissioning (aOR: 2.74, 95% CI: 2.13-3.54). Age disparities remained, whereby men aged 40-44 years had higher odds of PrEP use compared to those 18-24 years (aOR: 3.34, 95% CI: 1.93-5.78). Current PrEP users also reported higher healthcare engagement and sexual risk behaviours than those with unmet PrEP need. Meanwhile, unmet PrEP need declined significantly from 67.9% (431/635) in 2019 to 43.8% (212/484) in 2022 (p-value < 0.001). CONCLUSIONS: While routine PrEP commissioning increased PrEP use, age disparities remained, as did high levels of unmet PrEP need among GBMSM in London. This highlights the importance of targeted interventions to achieve equitable PrEP access.