Estimating the proportion of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities

Maddalena Cordioli, Lorenzo Gios, Jörg Huber, Nigel Sherriff, Cinta Folch, Ivailo Alexiev, Sonia Dias, Christiana Nöstlinger, Ana Gama, Emilia Naseva, Danica Stanekova, Marcus Ulrich, Susanne Schink, Magdalena Rosińska, Karel Blondeel, Igor Toskin, Massimo Mirandola

Research output: Contribution to journalArticle


Objectives: This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from Pre-Exposure Prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, SDET score) and drawing on a large-scale multi-site bio-behavioural survey (Sialon II). Methods: The Sialon II study was a bio-behavioural survey amongst MSM implemented in 13 European cities using either Time Location (TLS) or Respondent Driven Sampling (RDS). Biological and behavioural data from 4,901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk amongst MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. Results: 4,219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r >0.6), their concordance was highly variable (.01 <CCC <0.62). Conclusion: Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV amongst MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.
Original languageEnglish
JournalSexually Transmitted Infections
Publication statusAccepted/In press - 8 Nov 2020


  • PreP
  • HIV
  • STI
  • MSM
  • Public Health
  • Health Promotion
  • Europe
  • Bio-behavioural survey

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