Estimating the potential need for HIV pre-exposure prophylaxis in Italy: A national modelling study

Despite the expanding implementation of HIV pre-exposure prophylaxis (PrEP) across Europe, substantial gaps in access and uptake remain. We aimed to estimate the size and distribution of the population potentially eligible for PrEP in Italy using available demographic, epidemiological and behavioural data.

A deterministic modelling framework was developed to estimate the population potentially eligible for PrEP in Italy. The model integrated national demographic data with epidemiological and behavioural indicators associated with increased HIV acquisition risk. Estimates were generated for key population groups, including men who have sex with men (MSM), cisgender heterosexual men and women and transgender and non-binary individuals. Female sex workers were assessed separately because of potential overlap with other risk categories.

The model estimated that approximately 205 000 individuals in Italy may be eligible for PrEP (range: 170000-240 000). MSM accounted for the majority of the potentially eligible population, with an estimated 162 000 individuals (≈79%). Additional populations included 29 000 cisgender heterosexual men (≈14%), 9500 cisgender heterosexual women (≈5%) and 4600 transgender and non-binary individuals (≈2%). A further 13 900 female sex workers were estimated to engage in substantial HIV risk behaviours; however, they were excluded from the overall total because of possible overlap with other population groups.

Our findings suggest that a substantial number of individuals at risk of HIV acquisition in Italy may be eligible for PrEP, with MSM representing the largest group but with important contributions from other populations traditionally underrepresented in PrEP programmes. Although some estimates relied on dated survey data and proxy assumptions, the results highlight the need for strengthened national PrEP surveillance and monitoring systems, improved characterization of underserved populations and targeted strategies to reduce gaps in PrEP access and uptake.