Pre-exposure prophylaxis in France: How many MSM are eligible and how much will it cost?

Background Pre-exposure prophylaxis (PrEP) was definitively authorized in France in 2017 after a two-year probationary period. The fact that the estimated number of MSM eligible for PrEP is still unknown is a barrier to this prevention tool's roll-out at the national level. This study aimed to estimate the number of MSM eligible for PrEP in France, and to evaluate the direct cost of its roll-out. Methods We used data from several sources including the Enquete Rapport au Sexe 2019-ERAS 2019 survey, the 2019 French population census from National Institute of Statistics and Economic Studies (INSEE), and the National Public Health Agency's (Sante Publique France) 2016 health barometer survey. We also used data from previous studies which estimated the proportion of MSM who were sexually active in the 12 months prior to the studies, and HIV prevalence in MSM in France. Furthermore, we used data on PrEP drug costs from the French public drug database and data on medical examinations costs from the IPERGAY study. Results For 2019, the number of HIV seronegative MSM in France who were sexually active in the previous 12 months was estimated at 398,015. Of these, 142,379 (95%CI: 139,893-145,241) and 104,645 (95%IC: 102311-106979) were eligible for PrEP, based on the Menza score and on official French criteria, respectively. The overall estimated cost of PrEP roll-out in eligible MSM varied between Euro 317,685,216 and Euro 545,903,216 for official French criteria, which was higher than the estimated Euro432,240,851 and Euro742,753,074 according to the Menza score. Conclusions Our estimations will enable policy makers to make evidence-based decisions about PrEP roll-out to MSM in France. To accelerate the process, it is important to decentralize PrEP delivery, authorize general practitioners to write prescriptions, and promote this prevention tool through information campaigns.

Automated summary

This study aimed to estimate the number of men who have sex with men (MSM) eligible for pre-exposure prophylaxis (PrEP) in France and evaluate the direct cost of PrEP roll-out. Based on the study findings, there were approximately 398,015 sexually active HIV-negative MSM in 2019, and an estimated 142,379 and 104,645 individuals eligible for PrEP according to Menza score and official French criteria, respectively. The overall estimated cost of PrEP roll-out for eligible MSM ranged from Euro 317,685,216 to Euro 545,903,216 according to official French criteria. To accelerate the process, the study suggests decentralizing PrEP delivery, authorizing general practitioners to write prescriptions, and promoting PrEP through information campaigns.