Perspective Open Access
Like 0


Several countries in the European Union (EU) and European Economic Area (EEA) established and/or scaled up HIV pre-exposure prophylaxis (PrEP) programmes between 2016 and 2023. Data on PrEP programmes’ performance and effectiveness in reaching those most in need will be needed to assess regional progress in the roll-out of PrEP. However, there is a lack of commonly defined indicators for routine monitoring to allow for minimum comparability. We propose a harmonised PrEP monitoring approach for the EU/EEA, based on a systematic and evidence-informed consensus-building process involving a broad and multidisciplinary expert panel. We present a set of indicators, structured along relevant steps of an adapted PrEP care continuum, and offer a prioritisation based on the degree of consensus among the expert panel. We distinguish between ‘core’ indicators deemed essential for any PrEP programme in the EU/EEA, vs ‘supplementary’ and ‘optional’ indicators that provide meaningful data, yet where experts evaluated their feasibility for data collection and reporting as very context-dependent. By combining a standardised approach with strategic opportunities for adaptation and complementary research, this monitoring framework will contribute to assess the impact of PrEP on the HIV epidemic in Europe.


Article metrics loading...

Loading full text...

Full text loading...



  1. European Centre for Disease Prevention and Control (ECDC). Continuum of HIV care - Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia: 2021 progress report. Stockholm: ECDC; 2021. Available from: http://www.ecdc.europa.eu/en/publications-data/continuum-hiv-care-monitoring-implementation-dublin-declaration-partnership-fight
  2. World Health Organization (WHO). WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). Geneva: WHO; 2015; Available from: https://apps.who.int/iris/bitstream/handle/10665/197906/WHO_HIV_2015.48_eng.pdf?sequence=1&isAllowed=y
  3. European Centre for Disease Prevention and Control (ECDC). Pre-exposure prophylaxis to prevent HIV among MSM in Europe. Stockholm: ECDC; 2015; Available from: https://www.ecdc.europa.eu/en/news-events/pre-exposure-prophylaxis-prevent-hiv-among-msm-europe
  4. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973-83.  https://doi.org/10.1097/QAD.0000000000001145  PMID: 27149090 
  5. European Medicines Agency (EMA). First medicine for HIV pre-exposure prophylaxis recommended for approval in the EU. Amsterdam: EMA; 2016; Available from: https://www.ema.europa.eu/en/news/first-medicine-hiv-pre-exposure-prophylaxis-recommended-approval-eu
  6. European Centre for Disease Prevention and Control (ECDC). Pre-exposure prophylaxis for HIV prevention in Europe and Central Asia: Monitoring implementation of the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia – 2022 progress report. Stockholm: ECDC; 2023; Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-infection-prevention-pre-exposure-prophylaxis-monitoring-dublin
  7. Hargreaves JR, Delany-Moretlwe S, Hallett TB, Johnson S, Kapiga S, Bhattacharjee P, et al. The HIV prevention cascade: integrating theories of epidemiological, behavioural, and social science into programme design and monitoring. Lancet HIV. 2016;3(7):e318-22.  https://doi.org/10.1016/S2352-3018(16)30063-7  PMID: 27365206 
  8. World Health Organization (WHO). WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection. Module 5: Monitoring and evaluation. Geneva: WHO; 2018. Available from: https://apps.who.int/iris/handle/10665/279834
  9. European Centre for Disease Prevention and Control (ECDC). Country case studies: ECDC operational guidance on pre-exposure prophylaxis (PrEP) in the EU/EEA and the UK. Stockholm: ECDC; 2021. Available from: http://www.ecdc.europa.eu/en/publications-data/country-case-studies-ecdc-operational-guidance-prep
  10. European Centre for Disease Prevention and Control (ECDC). HIV pre-exposure prophylaxis in the EU/EEA and the UK: implementation, standards and monitoring. Stockholm: ECDC; 2021. Available from: http://www.ecdc.europa.eu/en/publications-data/HIV-PrEP-eueea-and-uk-implementation-standards-monitoring-guidance
  11. Wijstma E, Vanhamel J, Deblonde J, Nöstlinger C, Noori T, Vuylsteke B, et al. An overview of programmatic indicators to monitor the roll-out of HIV preexposure prophylaxis. AIDS. 2023;37(1):1-17.  https://doi.org/10.1097/QAD.0000000000003399  PMID: 36476453 
  12. Wijstma E, Vanhamel J, Vuylsteke B, Laga M, Nöstlinger C, Deblonde J, et al. Towards the development of a programmatic monitoring approach for the roll-out of HIV pre-exposure prophylaxis: a scoping review. Open Science Framework; 2021; Available from: https://osf.io/2axhs
  13. Garnett GP, Hallett TB, Takaruza A, Hargreaves J, Rhead R, Warren M, et al. Providing a conceptual framework for HIV prevention cascades and assessing feasibility of empirical measurement with data from east Zimbabwe: a case study. Lancet HIV. 2016;3(7):e297-306.  https://doi.org/10.1016/S2352-3018(16)30039-X  PMID: 27365204 
  14. Woodcock T, Adeleke Y, Goeschel C, Pronovost P, Dixon-Woods M. A modified Delphi study to identify the features of high quality measurement plans for healthcare improvement projects. BMC Med Res Methodol. 2020;20(1):8.  https://doi.org/10.1186/s12874-019-0886-6  PMID: 31937262 
  15. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841-9.  https://doi.org/10.1016/j.annepidem.2018.06.005  PMID: 29983236 
  16. European Centre for Disease Prevention and Control (ECDC). Monitoring HIV pre-exposure prophylaxis programmes in the EU/EEA. Stockholm: ECDC; 2022; Available from: https://www.ecdc.europa.eu/en/publications-data/monitoring-hiv-pre-exposure-prophylaxis-programmes-eueea

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error