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Using two national surveys, the GBQ\u2009+\u2009Community Periodic Surveys (GCPS, 2014\u20132023, N\u2009=\u200978,378) and the PrEPARE Project (2017\u20132023, N\u2009=\u20095,278), we constructed and iteratively refined cascades to monitor PrEP suitability, awareness, use, and service engagement. The PrEPARE cascade also included willingness, provider engagement and psychosexual benefits of PrEP. By 2023, both cascades showed near-universal PrEP awareness among PrEP-suitable participants. In the GCPS cascade, PrEP use increased from\u2009&lt;\u20091% of PrEP-suitable participants in 2014 to 30% in 2023, while in PrEPARE it increased from 21% in 2017 to 46% in 2023. However, in 2023, 29% of GCPS participants who were suitable and aware were not using PrEP, and 14% of PrEPARE participants who were PrEP-suitable and aware were unwilling to use it. PrEP use was lower among younger participants, bisexual and queer-identified participants compared with gay-identified participants, those outside metropolitan areas, and migrants without government-subsidised healthcare. Australia is among the few countries with repeated PrEP cascades that have been revised as implementation has evolved. We show that Australia has achieved near-universal PrEP awareness but highlight persistent inequities in uptake. Our findings demonstrate the value of long-term cascade monitoring and the need to address financial, geographic, and risk-perception barriers to close remaining gaps.<\/jats:p>","DOI":"10.1007\/s10461-026-05100-x","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T04:52:35Z","timestamp":1773723155000},"page":"3059-3073","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Decade of HIV Pre-Exposure Prophylaxis (PrEP) Cascade Monitoring: National Trends and Persistent Gaps in PrEP Use Among Gay, Bisexual and Queer Men and Non-Binary People in Australia"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-9572","authenticated-orcid":false,"given":"James","family":"MacGibbon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8465-7664","authenticated-orcid":false,"given":"Daniel","family":"Storer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4341-1868","authenticated-orcid":false,"given":"Timothy R.","family":"Broady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-0208","authenticated-orcid":false,"given":"Sarah K.","family":"Calabrese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0005-9542","authenticated-orcid":false,"given":"Anthony K. 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SKC has received indirect compensation and support for travel from Gilead Sciences and ViiV Healthcare. TRB has received honoraria from Gilead Sciences and ASHM Health, unrelated to the submitted work. DAM has received grant funding and honoraria from Gilead Sciences and ViiV Healthcare unrelated to the submitted work. None of the other authors have any conflicts of interest to declare. SKC, BRB and MH hold editorial roles with\n                      AIDS and Behavior\n                      . To mitigate this potential conflict of interest they were blinded from the peer review process.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures were performed in compliance with relevant laws and institutional guidelines. The GCPS (Ref. iRECS4718) and the PrEPARE Project (Ref. HC230024) have been approved by the Human Research Ethics Committee of the University of New South Wales (UNSW Sydney). The research ethics committees of the community organisations ACON and Thorne Harbour Health provided additional ethical oversight. All authors attest they meet the ICMJE criteria for authorship.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}