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Original research
Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities
  1. Maddalena Cordioli1,
  2. Lorenzo Gios1,
  3. Jörg W Huber2,
  4. Nigel Sherriff2,
  5. Cinta Folch3,
  6. Ivailo Alexiev4,
  7. Sónia Dias5,
  8. Christiana Nöstlinger6,
  9. Ana Gama5,
  10. Emilia Naseva7,
  11. Danica Valkovičová Staneková8,
  12. Ulrich Marcus9,
  13. Susanne Barbara Schink9,
  14. Magdalena Rosinska10,
  15. Karel Blondeel11,12,
  16. Igor Toskin12,
  17. Massimo Mirandola1,2
  1. 1Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
  2. 2School of Health Sciences, University of Brighton, Brighton, UK
  3. 3Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain - Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Madrid, Spain
  4. 4National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
  5. 5NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
  6. 6Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  7. 7Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
  8. 8NRC for HIV/AIDS Prevention, Slovak Medical University, Bratislava, Slovakia
  9. 9Department of Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
  10. 10Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland
  11. 11Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
  12. 12UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Maddalena Cordioli, Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona 37129, Italy; maddalena.cordioli{at}


Objectives This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II).

Methods The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria.

Results 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01<CCC<0.62).

Conclusion Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.

  • pre-exposure prophylaxis
  • sexual behaviour
  • HIV
  • preventive health services
  • public health

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  • Handling editor Jason J Ong

  • Contributors The Sialon II network participated in the design and implementation of the study. This analysis was conceived by MC, MM and LG. Data were analysed by MM. The first draft was jointly written by MC, NS, MM, LG and JH. All authors revised the manuscript for content. All authors read and approved the final manuscript.

  • Funding This manuscript is based on data from the Sialon II project, co-funded under the European Commission Second Programme of Community Action in the field of Health (2008–2013) (Work Plan 2010).

  • Disclaimer The sole responsibility lies with the authors of this manuscript and the Commission is not responsible for any use that may be made of the information contained therein. Authors IT and KB alone are responsible for the views expressed in this publication and do not necessarily represent the decisions or the policies of the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) or the World Health Organization (WHO).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Sialon II master protocol was approved by the WHO Research Project Review Panel (RP2) and the WHO Research Ethics Review Committee (WHO-ERC: RPC557). Locally adapted protocols were approved by the relevant ethics committees in each participating city.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data can be obtained by the corresponding author on request, after the approval of the Sialon Editorial Board.