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Evaluating PrEP equity in Wales, UK, using triangulation of routine data sources.
Eleanor Cochrane1, Sophie Harker2, Josie Smith2
1Cwm Taf Morgannwg University Health Board, Abercynon, Wales, UK eleanor.cochrane3@wales.nhs.uk.
Sexually Transmitted Infections
|July 14, 2026
Summary
Gay, bisexual, and other men who have sex with men (GBMSM) in Wales show high HIV pre-exposure prophylaxis (PrEP) uptake. However, inequities persist across gender and ethnicity, highlighting limitations in routine data for evaluating uptake equity.
Area of Science:
- Public Health
- Epidemiology
- Sexual Health
Background:
- Gay, bisexual, and other men who have sex with men (GBMSM) in Wales exhibit high uptake of HIV pre-exposure prophylaxis (PrEP).
- This trend mirrors patterns observed in countries with historically high HIV incidence among GBMSM.
- Routine data and the PrEP-to-need ratio (PnR) were utilized to assess PrEP uptake equity in Wales in 2023.
Purpose of the Study:
- To evaluate the equity of PrEP uptake among key populations in Wales.
- To compare PrEP uptake against PrEP need using routine data.
- To identify sociodemographic factors associated with inequities in PrEP access.
Main Methods:
- The PrEP-to-need ratio (PnR) was redefined as the number of PrEP users divided by 'PrEP need'.
- PrEP need was assessed using both epidemiological data (new HIV diagnoses) and PrEP candidacy data from sexual health clinic (SHC) and Test and Post (T&P) users.
- PnRs and inequity ratios were calculated across various sociodemographic groups.
Main Results:
- In 2023, 2191 individuals received PrEP, with 76 new HIV diagnoses.
- PrEP candidates constituted 7% of SHC users and 14%-28% of T&P users.
- Significant inequities in PrEP prescription were observed, with men, White ethnicity, individuals aged 55+, and those in urban/less deprived areas showing higher uptake relative to need. Disparities were particularly notable for women and Black ethnicity groups.
Conclusions:
- The study identified significant inequities in PrEP uptake related to gender, ethnicity, age, location, and deprivation.
- Discrepancies in estimating equity gaps, especially for gender and ethnicity, underscore the limitations of routine data.
- Employing data and method triangulation enhances the characterization of PrEP uptake inequities in low-incidence settings.
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