PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

Deniz Gokengin^{1

2}, Dominik Bursa³, Agata Skrzat-Klapaczynska³, Ivailo Alexiev⁴, Elena Arsikj⁵, Tatevik Balayan⁶, Josip Begovac⁷, Alma Cicic⁸, Gordana Dragovic⁹, Arjan Harxhi¹⁰, Kerstin Aimla¹¹, Botond Lakatos¹², Raimonda Matulionyte¹³, Velida Mulabdic¹⁴, Cristiana Oprea¹⁵, Antonios Papadopoulos¹⁶, Nino Rukhadze¹⁷, Dalibor Sedlacek¹⁸, Lubomir Sojak¹⁹, Janez Tomazic²⁰, Anna Vassilenko²¹, Marta Vasylyev^{22

23}, Antonija Verhaz²⁴, Nina Yancheva²⁵, Oleg Yurin²⁶, Justyna Kowalska^{3

27}; Euroguidelines in Central and Eastern Europe (ECEE) Network Group

Affiliations

¹ Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye.
² HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye.
³ Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
⁴ Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria.
⁵ University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia.
⁶ National Center for Disease Control and Prevention, Yerevan 0025, Armenia.
⁷ Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
⁸ Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro.
⁹ Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
¹⁰ Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania.
¹¹ Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia.
¹² Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary.
¹³ Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania.
¹⁴ Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
¹⁵ Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania.
¹⁶ 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 12462 Athens, Greece.
¹⁷ Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia.
¹⁸ HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic.
¹⁹ Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer's University Hospital, 2412 Bratislava, Slovakia.
²⁰ Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia.
²¹ Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus.
²² Astar Medical Center, 79054 Lviv, Ukraine.
²³ Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands.
²⁴ Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina.
²⁵ Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases-Sofia, Medical University Sofia, 1431 Sofia, Bulgaria.
²⁶ Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia.
²⁷ HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.

PMID: 36679967
PMCID: PMC9867039
DOI: 10.3390/vaccines11010122

PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

Deniz Gokengin et al. Vaccines (Basel). 2023.

. 2023 Jan 4;11(1):122.

doi: 10.3390/vaccines11010122.

Authors

Affiliations

¹ Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ege University, Izmir 35100, Türkiye.
² HIV/AIDS Research and Practice Center, Ege University, Izmir 35100, Türkiye.
³ Department of Adults' Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.
⁴ Department of Virology, National Center of Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria.
⁵ University Clinic for Infectious Diseases and Febrile Conditions Skopje, Faculty of Medicine Skopje, Ss.Cyril and Methodius University, 1010 Skopje, North Macedonia.
⁶ National Center for Disease Control and Prevention, Yerevan 0025, Armenia.
⁷ Department of Infectious Diseases, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
⁸ Center for Communicable Disease Control and Prevention, Institute for Public Health of Montenegro, 81000 Podgorica, Montenegro.
⁹ Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
¹⁰ Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, 1001 Tirana, Albania.
¹¹ Department of Infectious Diseases, Tartu University Hospital, 50406 Tartu, Estonia.
¹² Department of HIV and Tropical Diseases, South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary.
¹³ Department of Infectious Diseases and Dermatovenerology, Vilnius University Hospital Santaros Klinikos, Vilnius University, LT-08410 Vilnius, Lithuania.
¹⁴ Clinic for Infectious Diseases, Clinical Center University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
¹⁵ Victor Babes Hospital for Infectious and Tropical Diseases, Carol Davila University of Medicine and Pharmacy, 030303 Bucharest, Romania.
¹⁶ 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", 12462 Athens, Greece.
¹⁷ Infectious Diseases, AIDS & Clinical Immunology Research Center, 0160 Tbilisi, Georgia.
¹⁸ HIV Center University Hospital, Charles University, 11000 Pilsen, Czech Republic.
¹⁹ Center for Treatment of HIV/AIDS Patients, Department of Infectology and Geographical Medicine, Academic L. Derer's University Hospital, 2412 Bratislava, Slovakia.
²⁰ Department of Infectious Diseases, University Medical Center Ljubljana, 1525 Ljubljana, Slovenia.
²¹ Global Fund Grant Management Department, Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RNPT MT), 220013 Minsk, Belarus.
²² Astar Medical Center, 79054 Lviv, Ukraine.
²³ Internal Medicine Department, Erasmus MC, 2040 3000 Rotterdam, The Netherlands.
²⁴ Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina.
²⁵ Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases-Sofia, Medical University Sofia, 1431 Sofia, Bulgaria.
²⁶ Department of AIDS, Epidemiology and Prevention, Central Research Institute of Epidemiology, Federal AIDS Centre, 111123 Moscow, Russia.
²⁷ HIV Out-Patient Clinic, Hospital for Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland.

PMID: 36679967
PMCID: PMC9867039
DOI: 10.3390/vaccines11010122

Abstract

With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.

Keywords: Central and Eastern Europe; HIV; post-exposure prophylaxis; pre-exposure prophylaxis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
PrEP type available in countries (n = 15) where PrEP is licensed.

See this image and copyright information in PMC

References

1. Eastern Europe and Central Asia may Face an Accelerated Increase in New HIV Infections and AIDS-Related Deaths Because of the Humanitarian Crisis Gripping the Entire Region. UNAIDS. [(accessed on 12 November 2022)]. Available online: https://www.unaids.org/en/keywords/eastern-europe-and-central-asia#:~:te....
1. European Centre for Disease Prevention and Control, WHO Regional Office for Europe HIV/AIDS Surveillance in Europe 2020–2019 Data. Stockholm: ECDC. 2020. [(accessed on 12 November 2022)]. Available online: https://www.ecdc.europa.eu/sites/default/files/documents/hiv-surveillanc....
1. European Centre for Disease Prevention and Control, WHO Regional Office for Europe HIV/AIDS Surveillance in Europe 2022–2021 Data. Copenhagen: WHO Regional Office for Europe. 2022. [(accessed on 15 December 2022)]. Available online: https://reliefweb.int/report/world/hivaids-surveillance-europe-2022–2021....
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1. Skrzat-Klapaczynska A., Kowalska J.D., Afonina L., Antonyak S., Balayan T., Begovac J., Bursa D., Dragovic G., Gokengin D., Harxhi A., et al. The Management of HIV Care Services in Central and Eastern Europe: Data from the Euroguidelines in Central and Eastern Europe Network Group. Int. J. Environ. Res. Public Health. 2022;19:7595. doi: 10.3390/ijerph19137595. - DOI - PMC - PubMed

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PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

Affiliations

PrEP Scale-Up and PEP in Central and Eastern Europe: Changes in Time and the Challenges We Face with No Expected HIV Vaccine in the near Future

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous