PrEP implementation in Belgium: Studying PrEP users’ behaviours, attitudes and care needs

Pre-exposure prophylaxis (PrEP) entails the use of antiretroviral medication for the prevention of HIV. More than a decade ago, the first evidence of its efficacy emerged. Nowadays, this novel tool is well recognized and integrated in the combination HIV prevention approach.(1) While the feasibility and acceptability of delivering PrEP to various key populations have been demonstrated, implementation has not yet reached the full potential of this prevention measure.(2) At the beginning of 2021, more than a million persons have initiated PrEP worldwide. However, with the exception of a few regions, the relationship between PrEP coverage and HIV diagnosis rates at a population level remains elusive.(3) Successful PrEP implementation therefore requires more than just increasing the number of its users. For PrEP to have the greatest impact on the HIV epidemic it must be taken correctly and persistently by those at substantial risk for HIV.(1) As such, PrEP interventions optimization requires a thorough understanding about who is using PrEP, their long-term patterns of PrEP use and how they perceive other already wellestablished HIV prevention strategies, such as condoms, since PrEP is available. Since 2017, Belgium is one of the first European countries offering reimbursed PrEP. The delivery model runs through specialized HIV centres, which PrEP users are expected to visit every three months for PrEP prescriptions, counselling and STI check-up.(4) Whether everyone receiving PrEP needs to be engaged in care in the same way, as is currently the case, is questionable. As with HIV care, a one-size-fitsall approach will not fit the needs of every PrEP user. In order to move to a more tailored, client-centred and differentiated PrEP care delivery model, as suggested by the World Health Organization, it is crucial to first identify the different PrEP user needs in terms of PrEP care.(5) The goal of this thesis is to gain insights into PrEP users’ behaviours and needs for PrEP care. These insights will be useful for understanding PrEP programme implementation and are necessary to provide guidance for PrEP care optimization.