Implementation of HIV pre-exposure prophylaxis (PrEP) in Italy (2023-2024): Results from the PrIDE cohort survey

Objectives Italy introduced reimbursement for oral HIV pre-exposure prophylaxis (PrEP) in 2023. We examined PrEP implementation in Italy from 2023 to 2024 to evaluate regional uptake. Methods A nationwide survey within the scope of the PrIDE cohort (NCT07186244) was conducted across 62 infectious diseases and community-based centers in Italy in 2023 and 2024. Data were collected on individuals who started PrEP and those in follow-up, demographics, and the people with HIV (PWH) to PrEP users ratio, as proxy for unmet prevention need. We compared metrics before and after PrEP reimbursement and analyzed regional disparities. Results PrEP uptake increased substantially in 2024, with a cumulative number of users increasing by 51.6% (10,697 in 2023, 16,220 in 2024). Growth was uneven across regions: Sardinia (+71.4%), Friuli (+65.4%), and Emilia-Romagna (+54.7%) experienced the most significant increases. Most PrEP users remain concentrated in certain regions (Lombardy, Lazio, and Emilia-Romagna accounting for 75.6%) and were male (95.7%). Overall, 11,785/16,220 (72.7%) individuals were retained in care through 2024. The PWH/PrEP ratio improved nationally in 2024, but remained high in some areas. Conclusion The PrIDE survey shows an increase in PrEP uptake and services expansion after reimbursement in Italy. However, significant regional disparities and structural barriers endure.