TY - JOUR
T1 - The unseen impact of affordability
T2 - copayment sensitivity for long-acting PrEP among MSM in six European Countries, October 2023–April 2024
AU - Wang, Haoyi
AU - Kolstee, Johann
AU - Zimmermann, Hanne M.L.
AU - Jonas, Kai J.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2026/1/8
Y1 - 2026/1/8
N2 - Background: Long-acting pre-exposure prophylaxis (LA-PrEP) is approved in Europe with promising HIV prevention potential. Currently, no data are available that examine intention to use LA-PrEP intention when it is not fully covered by healthcare/insurance programs. We investigated how the affordability of LA-PrEP impacts the intention to use LA-PrEP by men who have sex with men (MSM) in six European countries.Methods: We included 10,592 HIV-negative MSM from an online cross-sectional survey (PROTECT, October 2023–April 2024), with participants from France (n = 1965), Germany (n = 2268), Italy (n = 1707), Spain (n = 1985), the United Kingdom (n = 1218) and the Netherlands (n = 1449). We investigated the intention to use LA-PrEP if one showed interest under different levels of affordability. For those who showed intention to use LA-PrEP when out-of-pocket copayments were required, we explored their intention by different copayments (ranging from < €50/month to €1000 + /month). We used multinomial regression to explore the impact of individual income on their intention to use LA-PrEP across different affordability/copayment scenarios. Results: Of the included MSM, 59%-79% showed LA-PrEP interest in these six countries. Among them, a consistent decline in the LA-PrEP intention was observed as affordability decreased: from 44%(FR)–91%(NL) at high affordability to 10%(DE)–26%(NL) at low affordability. MSM with a high income showed significantly higher intention under medium and low affordability scenarios in all countries. Among those who showed intention with copayments, a strongly declining intention was observed and reached almost 0% when the copayment exceeded €250/month in all countries. MSM with high income showed significantly higher intention when copayment was under €250/month in all countries. Conclusions: LA-PrEP would be welcomed in Europe if affordable. When LA-PrEP is not fully-covered, MSM with a high income may be the early adopters. However, LA-PrEP may not be affordable for those with a reason to use LA-PrEP once monthly copayments exceed €250, stressing the need for availability under insurance plans, or with limited copayments.
AB - Background: Long-acting pre-exposure prophylaxis (LA-PrEP) is approved in Europe with promising HIV prevention potential. Currently, no data are available that examine intention to use LA-PrEP intention when it is not fully covered by healthcare/insurance programs. We investigated how the affordability of LA-PrEP impacts the intention to use LA-PrEP by men who have sex with men (MSM) in six European countries.Methods: We included 10,592 HIV-negative MSM from an online cross-sectional survey (PROTECT, October 2023–April 2024), with participants from France (n = 1965), Germany (n = 2268), Italy (n = 1707), Spain (n = 1985), the United Kingdom (n = 1218) and the Netherlands (n = 1449). We investigated the intention to use LA-PrEP if one showed interest under different levels of affordability. For those who showed intention to use LA-PrEP when out-of-pocket copayments were required, we explored their intention by different copayments (ranging from < €50/month to €1000 + /month). We used multinomial regression to explore the impact of individual income on their intention to use LA-PrEP across different affordability/copayment scenarios. Results: Of the included MSM, 59%-79% showed LA-PrEP interest in these six countries. Among them, a consistent decline in the LA-PrEP intention was observed as affordability decreased: from 44%(FR)–91%(NL) at high affordability to 10%(DE)–26%(NL) at low affordability. MSM with a high income showed significantly higher intention under medium and low affordability scenarios in all countries. Among those who showed intention with copayments, a strongly declining intention was observed and reached almost 0% when the copayment exceeded €250/month in all countries. MSM with high income showed significantly higher intention when copayment was under €250/month in all countries. Conclusions: LA-PrEP would be welcomed in Europe if affordable. When LA-PrEP is not fully-covered, MSM with a high income may be the early adopters. However, LA-PrEP may not be affordable for those with a reason to use LA-PrEP once monthly copayments exceed €250, stressing the need for availability under insurance plans, or with limited copayments.
UR - https://www.scopus.com/pages/publications/105027163063
U2 - 10.1038/s41598-025-30474-8
DO - 10.1038/s41598-025-30474-8
M3 - Article
C2 - 41350365
AN - SCOPUS:105027163063
SN - 2045-2322
VL - 16
JO - Scientific Reports
JF - Scientific Reports
IS - 1
M1 - 968
ER -
