SIPrEP: A tool to monitor HIV pre-exposure prophylaxis in Spain.

Abstract

Objectives: Pre-exposure prophylaxis (PrEP) has been available in Spain since November 2019 and implemented nationally in 2021. Monitoring the implementation process is essential to optimize the strategy. This manuscript describes the Spanish PrEP Programme Information System (SIPrEP), its methodology, and characteristics of PrEP users from November 2019 to May 2024. Methods: Nationwide open cohort that collects data on persons ≥16 years who were prescribed PrEP in Spain. The study included participants with public program PrEP prescriptions since November 1, 2019. The project was piloted and fully implemented in July 2020. Results: By May 2024, 28,798 people received public program PrEP in Spain, and 4159 users were included in SIPrEP. Most were men (99%, n=4117), primarily gay, bisexual, and other men who have sex with men (GBMSM) (97%, n=4005), with a median age of 36 years (IQR: 30-43). Most were born in Spain (74%, n=3075), and 36% (n=1503) had university education. Referrals came from STI centers (19%, n=805) and primary care (20%, n=820). At entry, 8% (n=348) had syphilis, 7% chlamydia (n=270) and 7% (n=300) had gonococcal infection. Among users, 15% (n=642) discontinued PrEP, and 34% (n=216) of them restarted later. There were four HIV seroconversions (incidence 0.12/100 person-years [95% CI: 0.05-0.33]). Conclusions: SIPrEP provides valuable real-world data for optimizing interventions but requires improved national coverage.