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Title
Just how far off target are we? Measuring unmet pre-exposure prophylaxis (PrEP) need among men who have sex with men (MSM) and transgender women (TGW) in Asia
Presenter
Kimberly E. Green
Authors
K.E. Green1, C. Chan2, M.M. Cassell3, J. Ong4,5,6, D. Fraser2, L. Zhang7, M. Poonkasetwattana8, N. Suwandi8, N. Phanupak9, H. Boonyapisomparn10, B.R. Bavinton2, H.-M.A. Schmidt11,12
Institutions
1PATH, Hanoi, Vietnam, 2University of New South Wales, Kirby Institute, Sydney, Australia, 3FHI 360, HIV Department, Hanoi, Vietnam, 4Alfred Health, Melbourne Sexual Health Centre, Melbourne, Australia, 5Monash University, Central Clinical School, Melbourne, Australia, 6London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, United Kingdom, 7School of Public Health, Xi'an Jiaotong University Health Science Center, China-Australia Joint Research Centre for Infectious Diseases, Xi'an, China, 8Asia Pacific Coalition on Male Sexual Health, Bangkok, Thailand, 9Institute of HIV Research and Innovation, Bangkok, Thailand, 10Asia Pacific Transgender Network, Bangkok, Thailand, 11UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand, 12World Health Organization, Global HIV, Hepatitis and STIs Programme, Geneva, Switzerland

BACKGROUND: Despite recent efforts to expand oral pre-exposure prophylaxis (PrEP) access in Asia, uptake has lagged significantly behind the regional 2025 target, with only 3% of the 4 million goal achieved. We aimed to measure unmet PrEP need among men who have sex with men (MSM) and transgender women (TGW) in Asia to inform scale-up strategies.
METHODS: We implemented an online cross-sectional survey among MSM and TGW across 15 and 11 countries or territories in Asia, respectively, from May to November 2022. Participants were asked about potential HIV risk, PrEP use history, and PrEP product and service preferences. We defined unmet PrEP need as those who had: 1) heard of and wanted to take PrEP but had never taken it; 2) never heard of PrEP but had HIV risk factors indicating need; 3) taken oral PrEP but preferred a different PrEP product (e.g., long-acting PrEP); or 4) had temporarily discontinued oral PrEP due to a barrier (side effects, not liking pills, cost) but still needed it. We generated descriptive statistics and used multivariable logistic regression models to identify factors associated with unmet PrEP need.
RESULTS: Among 17,032 MSM and 1,260 TGW surveyed, 10,195 (59.9%) MSM and 598 (47.5%) TGW were found to have unmet PrEP need: 1) 6,130 (60.1%) MSM and 202 (33.8%) TGW were PrEP-naïve but wanted to take it; 2) 1,368 (13.4%) MSM and 134 (22.4%) TGW were unaware of PrEP but reported risk factors indicative of need; 3) 2,004 (19.7%) MSM and 182 (30.4%) TGW were taking oral PrEP but preferred using a different product; 4) 693 (6.8%) MSM and 80 (13.4%) TGW had temporarily discontinued PrEP due to a barrier. Knowing fewer people who took PrEP (aOR=1.85; 95%CI:1.72-2.00), condomless anal sex in past 6 months (aOR=1.64 95%CI:1.54-1.75), and younger age (aOR=1.02 95%CI:1.01-1.02) were positively associated with unmet PrEP need.
CONCLUSIONS: We identified substantial unmet PrEP need among MSM and TGW respondents, in the largest known regional study on PrEP in Asia. Urgent investment is needed to increase PrEP awareness and service access, accompanied by a wider selection of products, that best align with what TGW and MSM need and want.

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