Just how far off target are we? Measuring unmet pre-exposure prophylaxis need among men who have sex with men and transgender women in Asia-Pacific.

BACKGROUND

Oral HIV pre-exposure prophylaxis (PrEP) uptake in the Asia-Pacific region is sub-optimal with only 2% of the 2025 goal of PrEP use achieved in 2023. There is no agreed-on measure of unmet PrEP need, and no assessment of unmet need across the Asia-Pacific.

METHODS

We surveyed men who have sex with men (MSM) and transgender women (TGW) in 15 Asian countries and Australia (16 total). We defined unmet PrEP need as those who had: (1) heard of and wanted to take PrEP, but never taken it; (2) never heard of PrEP but had HIV risk factors; (3) taken oral PrEP but preferred a different PrEP product; or (4) temporarily discontinued oral PrEP due to a barrier. Descriptive statistics and multivariable logistic regression models identifed factors associated with unmet PrEP need.

RESULTS

Among 17,032 MSM and 1260 TGW surveyed, 59.9% MSM and 47.5% TGW had unmet PrEP need. The most common unmet PrEP need was being PrEP-naïve but wanting to take PrEP (55.6% MSM; 31.2% TGW), followed by being a current oral PrEP user but preferring to use a different product (18.2% MSM; 28.1% TGW), being unaware of PrEP but reporting risk factors indicative of PrEP need (12.4% MSM; 20.7% TGW), and temporarily discontinued PrEP due to a barrier to accessing services (13.8% MSM; and 19.9% TGW).

CONCLUSIONS

Unmet need is a critical measure of PrEP access, uptake, and coverage. Unmet PrEP need in Asia-Pacific is exacerbated by funding cuts from international donors. Urgent action is needed to increase PrEP access to achieve its goal of ending HIV by 2030.