Implementation of HIV Pre-exposure Prophylaxis (PrEP) in Italy (2023-2024): Results from the PrIDE Cohort Survey

Background: 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. Conclusions: The PrIDE survey shows an increase in PrEP uptake and services expansion after reimbursement in Italy. However, significant regional disparities and structural barriers endure.