ComPrEmetidos: A Multidisciplinary Consensus to Transform HIV Prevention in Spain.

Despite progress in antiretroviral therapy and prevention, HIV remains a major public health challenge in Spain. Pre-exposure prophylaxis (PrEP) is a proven and effective prevention strategy, but challenges in access, equity, adherence and persistence limit its population impact. Our aim was to identify current barriers to PrEP adoption in Spain and develop actionable solutions. We conducted a structured consensus process (September 2024-May 2025) with 19 experts from fields including infectious diseases/HIV care, sexual health/sexually transmitted infection services, primary care, emergency medicine, nursing, pediatrics, hospital pharmacy, public health, epidemiology/biostatistics, and community-based organizations. It included semi-structured interviews, multidisciplinary small-group sessions, and two plenary workshops. Complementary descriptive surveys of healthcare professionals (HCPs) and NGO/community health centers (n = 150) and current/potential/past PrEP users (n = 95) provided contextual data. Consensus statements were developed using a facilitator-led approach based on nominal group techniques, with community representatives contributing lived-experience insights. The panel identified key challenges, including fragmented access (hospital-centered), capacity constraints, restrictive eligibility criteria, knowledge gaps, adherence and persistence issues, and limitations in information systems. To address these, a focused decalogue was developed to promote decentralization, equity, person-centered care and preparedness for transformative innovation in PrEP. The ComPrEmetidos consensus offers an operational roadmap to move Spain from policy availability to program performance and more effectively reduce new HIV infections in Spain. Priorities include decentralization, improving the training and knowledge of HCPs and the general public, rapid linkage to PrEP, and the incorporation of innovation, especially for those for whom oral PrEP is not sufficient.