TelePrEP in Italy: A remote service to expand equitable access to HIV pre-exposure prophylaxis

HIV pre-exposure prophylaxis (PrEP) access still appears to be disproportionate, with existing barriers. This study aims to describe the characteristics, retention and feasibility of TelePrEP, Italy's first remote PrEP service, which was launched in February 2023 to address inequities in PrEP access.

TelePrEP provides online PrEP counselling, prescriptions and follow-ups via community healthcare workers and infectious disease physicians, targeting individuals unable to attend in-person services in existing local services. Between February 2023 and April 2025, all enrolled clients underwent baseline risk assessment, laboratory testing at local facilities, remote clinical evaluation and follow-up every 3 months. Descriptive statistics analysed demographics, retention and clinical outcomes.

Of the 434 individuals who sought information about PrEP, 187 (43.1%) enrolled in TelePrEP, while 93 (21.4%) were directly referred to existing local PrEP services. The majority were assigned male at birth (97.3%), were identified as MSM (75.9%) and were 29-40 years old (43.9%). Of these, 57.2% held a university degree, and two-thirds (66.8%) lived in rural areas or small towns. The most common reasons for choosing TelePrEP were convenience and safety: 22.9% cited long hospital waiting times and 27.8% cited distance. Follow-up visits were completed by 104 individuals (55.6%), of whom 43.3% took daily oral PrEP and 52.9% on-demand. No HIV infections were recorded during the follow-up period. Of the 115 clients who discontinued the programme, 44 were linked to local PrEP services after starting PrEP remotely. Overall satisfaction was high, with 92.3% agreeing that PrEP improved their sexual well-being.

TelePrEP is a feasible, acceptable model overcoming systemic barriers to PrEP access in Italy, effectively reaching underserved populations, with no evidence of breakthrough HIV infections. Integration into national HIV strategies might improve equity and reduce healthcare burden.