Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need.

Objective: To quantify how many people in England could benefit from using pre-exposure prophylaxis (PrEP) to prevent HIV acquisition (PrEP need), and of these, the number who did not access PrEP (unmet need) by population group and ethnicity.

Methods: An established multiplier method was applied using published data from a behavioural survey of gay, bisexual and men who have sex with men (GBMSM) and national data on UK-acquired new HIV diagnoses categorised by ethnicity and probable HIV exposure route.After calculating the number of GBMSM who could benefit from PrEP, the number of people in other groups who could benefit from PrEP was calculated using the relative proportion of new HIV diagnoses within each group. The proportion of new HIV diagnoses by ethnicity was then used to calculate the number of people who could benefit from PrEP by ethnicity.Within each subgroup (population group and ethnicity), the number with unmet need for PrEP was calculated by subtracting those who accessed PrEP at a specialist sexual health service (SHS) from the estimated number who could benefit from PrEP.

Results: In 2023, there were an estimated 485 335 people who could benefit from PrEP in England, 80.1% (n=388 773) of whom did not access PrEP from an SHS-and of these, 94.5% (n=367 444) did not attend an SHS. There were 129 359 heterosexual women with unmet PrEP need, 93 049 GBMSM and 88 204 heterosexual men. There were three ethnicities for which >85% of people with PrEP need did not access PrEP: Black African (98.6%), Black other (96.3%) and Black Caribbean (85.4%).

Conclusions: The findings indicate a considerable unmet need for PrEP in England. Most people with unmet need did not attend an SHS, highlighting an urgent need to raise awareness of the benefits of PrEP and expand PrEP access to additional settings.