Driving progress towards PrEP equity: Key changes in the 2025 BASHH/BHIVA UK PrEP guidelines

Abstract

Objectives

Success in HIV prevention interventions, including pre-exposure prophylaxis (PrEP), among gay, bisexual and other men-who-have-sex-with-men (GBMSM) has not been replicated across all communities. The 2025 BASHH/BHIVA UK PrEP Guidelines recognizes and addresses the significant barriers and constraints that existing guidance and service delivery models place on PrEP access and equity. This paper summarizes the key guideline recommendations and the rationale supporting them.

Methods

The guidelines were developed following the methodology described in the CEG Framework for Guideline development published on the BASHH website. The writing group of clinicians, academics and community advocates incorporated input from a formal public consultation process.

Results

The 2025 guideline includes over 90 graded recommendations. A chapter on PrEP equity and an updated chapter on PrEP suitability and risk assessment, moving away from basing PrEP eligibility on the inclusion criteria used for clinical trials, are included. Injectable PrEP has demonstrated superiority to oral PrEP but presents challenges in delivery, so improving equity in access and uptake of existing oral PrEP options was a key priority. The guidelines simplify and clarify advice on dosing for oral PrEP and recommend new event-based dosing options for all PrEP users, including quick-start double-dose PrEP for everybody. New guidance on the use of PrEP after a potential exposure is also included.

Conclusions

The PrEP guidelines purposefully highlight equity, access and the urgent requirement to meet the needs of underserved communities as a priority. These are addressed through pragmatic and groundbreaking recommendations based on careful consideration of all available evidence.