HIV pre-exposure prophylaxis (PrEP) use among PrEP-eligible men who have sex with men: A systematic review and meta-analysis

Abstract

Objective: Scaling up pre-exposure prophylaxis (PrEP) is critical to combating the AIDS epidemic, especially among PrEP-eligible men who have sex with men (MSM). This study summarizes the global proportion of PrEP-eligible MSM with PrEP use and highlights the contextual differences in eligibility criteria for PrEP across studies.

Methods: A literature search was conducted in four databases in July 2023. We determined the proportion of PrEP-eligible MSM with PrEP use and its 95% confidence interval (CI) using a random-effects meta-analysis.

Results: 50 eligible studies involving 96,151 PrEP-eligible MSM were included. The overall pooled estimate of PrEP-eligible MSM with a history of PrEP use and current PrEP use was 19.3% (95% CI 13.9-26.2) and 21.8% (95% CI 17.6-26.7) with β regressions indicating an increasing trend. Subgroup analyses showed lower PrEP use among young MSM, and differences in PrEP use by research year, country income level, policy support and WHO region. Variations in eligibility criteria for PrEP were observed across studies.

Conclusions: An overall increase in PrEP use among PrEP-eligible MSM was observed, with differences in PrEP use mainly by age. Emphasis on identifying PrEP-eligible MSM, particularly young MSM and removing financial barriers for effective implementation. Global PrEP criteria should be more standardized and based on the latest science.

Keywords: HIV; Men who have sex with men; Meta-analysis; PrEP-eligibility; Pre-exposure prophylaxis (PrEP); Systematic review.