{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:58:01Z","timestamp":1789055881133,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100023448","name":"Robert Koch-Institut","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023448","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess the implications of HIV pre-exposure prophylaxis (PrEP) shortages, we conducted a survey among PrEP users and individuals interested in PrEP. The survey explored coping strategies, HIV prevention and sexual behavior and stress levels due to the drug shortages. Furthermore, barriers to PrEP access among people with unmet PrEP demand were investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymous online survey was conducted from 28.01.-27.02.2024. Recruitment occurred via social media, professional societies, network channels, and flyers at HIV specialists. Factors associated with high stress levels and unmet PrEP demand were investigated using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 926 PrEP users, most were male (98%), aged 31\u201345 (54%), identified as men (97%), lived in large cities (54%), and used PrEP daily (78%). Due to the shortage, 63% paused or switched to on-demand use. Most intended to resume PrEP once available (65%), followed by relying on condoms (41%) or reducing sexual partners (39%). High stress level was reported by 78%. Predictors of higher stress levels included feeling less protected against HIV and having more than 11 sexual partners; using on-demand PrEP with fewer than 20 monthly pills was significantly less likely. Unmet PrEP demand was more common among female and gender-diverse individuals and less common among those living in large cities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Involuntary changes in PrEP use may have hindered users\u2019 ability to adapt sexual behavior, increasing HIV risks. PrEP users most at risk and most reliant on PrEP experienced greater psychological burden. Expanding PrEP education and outreach alongside with prescriber capacity is essential to ensure PrEP continuity and meet unmet PrEP demand. Individualized counseling could help to determine actual PrEP need and benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-12086-9","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:41:58Z","timestamp":1763059318000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unsuspected drug shortage is impacting the German HIV PrEP supply - results of a cross-sectional survey show: majority of PrEP users had to stop or switch to on-demand PrEP and higher unmet PrEP demand among women, diverse individuals, and those in rural or small-town areas"],"prefix":"10.1186","volume":"25","author":[{"given":"Daniel","family":"Schmidt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Kirchner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Voulgaris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Friebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane","family":"Bremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bartmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"12086_CR1","unstructured":"Bundesministerium f\u00fcr Gesundheit. Terminservice- und Versorgungsgesetz (TSVG). 2019. p. Artikel 1 Nr. 9."},{"key":"12086_CR2","unstructured":"Schmidt D. Projekthomepage: Evaluation der Einf\u00fchrung der HIV-Pr\u00e4expositionsprophylaxe als Leistung der Gesetzlichen Krankenversicherung (EvE-PrEP). 2019 25.03.2025]; Available from: https:\/\/www.rki.de\/eve-prep."},{"key":"12086_CR3","unstructured":"Schmidt D, et al. Evaluation der Einf\u00fchrung der HIV-Pr\u00e4expositionsprophylaxe als Leistung der gesetzlichen Krankenversicherung (EvE\u2011PrEP). Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 2023: pp. 1\u201311."},{"key":"12086_CR4","unstructured":"Schmidt D. Projekthomepage: Surveillance der Versorgung mit der HIV-Pr\u00e4expositionsprophylaxe innerhalb der GKV in Deutschland (PrEP-Surv). 2022 25.03.2025]; Available from: https:\/\/www.rki.de\/hiv-prepsurv."},{"key":"12086_CR5","unstructured":"DAIG, Dagn\u00e4. and DAH2KA, Pressemitteilung: Mangel an HIV-Medikamenten: \u201eEs ist schlimmer, als wir zu f\u00fcrchten gewagt haben - Verb\u00e4nde und HIV-Expert:innen bef\u00fcrchten Anstieg der Neuinfektionen. Berlin, 16.1.2024."},{"key":"12086_CR6","unstructured":"DAH, Deutsche Aidshilfe: Mangel an HIV- und PrEP-Medikament: Der Bund muss jetzt handeln. 17.1.2024."},{"key":"12086_CR7","unstructured":"BMG, Bundesministerium f\u00fcr Gesundheit. Bekanntmachung Nach \u00a7 79 Absatz 5 des arzneimittelgesetzes vom 25. Januar 2024. Bundesanzeiger Bekanntmachung Ver\u00f6ffentlicht Am Donnerstag, 1. Februar 2024 BAnz AT 01.02.2024 B8."},{"key":"12086_CR8","unstructured":"gesund.bund.de - Arztsuche mit Vorauswahl f\u00fcr HIV-Pr\u00e4expositionsprophylaxe. 23.05.2025]; Available from: https:\/\/gesund.bund.de\/suchen\/aerztinnen-und-aerzte\/vorauswahl-hiv-prep."},{"issue":"12","key":"12086_CR9","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1109\/TVCG.2014.2346248","volume":"20","author":"A Lex","year":"2014","unstructured":"Lex A, et al. UpSet: visualization of intersecting sets. IEEE Trans Vis Comput Graph. 2014;20(12):1983\u201392.","journal-title":"IEEE Trans Vis Comput Graph"},{"key":"12086_CR10","unstructured":"Schmidt D, et al. PrEP-Surveillance in Deutschland \u2013 Ergebnisse der vierten halbj\u00e4hrlichen Befragung in HIV-Schwerpunkteinrichtungen. Epid Bull., 2024;48:8\u201319 | DOI 10.25646\/12927, 2024."},{"key":"12086_CR11","doi-asserted-by":"publisher","first-page":"1241310","DOI":"10.3389\/fphar.2023.1241310","volume":"14","author":"H Prins","year":"2023","unstructured":"Prins H, D\u00f6rre A, Schmidt D. Statutory health insurance-covered pre-exposure prophylaxis in Germany: changing trends in nationwide Tenofovir disoproxil\/emtricitabine prescriptions during the COVID-19 pandemic. Front Pharmacol. 2023;14:1241310.","journal-title":"Front Pharmacol"},{"issue":"1","key":"12086_CR12","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1186\/s12889-024-19198-y","volume":"24","author":"D Schmidt","year":"2024","unstructured":"Schmidt D, et al. Dynamics of HIV PrEP use and coverage during and after COVID-19 in Germany. BMC Public Health. 2024;24(1):1691.","journal-title":"BMC Public Health"},{"issue":"1","key":"12086_CR13","doi-asserted-by":"publisher","first-page":"e1020","DOI":"10.1093\/cid\/ciac038","volume":"75","author":"YLA Huang","year":"2022","unstructured":"Huang YLA, et al. Impact of coronavirus disease 2019 (COVID-19) on human immunodeficiency virus (HIV) pre-exposure prophylaxis prescriptions in the united States\u2014a time-series analysis. Clin Infect Dis. 2022;75(1):e1020\u20137.","journal-title":"Clin Infect Dis"},{"key":"12086_CR14","doi-asserted-by":"crossref","unstructured":"Ullrich A, et al. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in germany: an analysis of National surveillance data during week 1-2016 - week 32-2020. The Lancet Regional Health \u2013 Europe; 2021. p. 6.","DOI":"10.1016\/j.lanepe.2021.100103"},{"key":"12086_CR15","doi-asserted-by":"crossref","unstructured":"de Gage SB, Desplas D, Dray-Spira R. Roll-out of HIV pre-exposure prophylaxis use in France: a nationwide observational study from 2016 to 2021. The Lancet Regional Health\u2013Europe. 2022:22.","DOI":"10.1016\/j.lanepe.2022.100486"},{"key":"12086_CR16","doi-asserted-by":"crossref","unstructured":"Acharya A et al. Mpox in MSM: tackling stigma, minimizing risk factors, exploring pathogenesis, and treatment approaches. Biomed J. 2024:100746.","DOI":"10.1016\/j.bj.2024.100746"},{"issue":"9","key":"12086_CR17","doi-asserted-by":"publisher","first-page":"3663","DOI":"10.1007\/s10508-024-02922-5","volume":"53","author":"F Valbert","year":"2024","unstructured":"Valbert F, et al. Routine data analysis of HIV pre-exposure prophylaxis use and rates of sexually transmitted infections since coverage of HIV Pre-Exposure prophylaxis by the statutory health insurance in Germany. Arch Sex Behav. 2024;53(9):3663\u201372.","journal-title":"Arch Sex Behav"},{"issue":"8","key":"12086_CR18","doi-asserted-by":"publisher","first-page":"e2122692","DOI":"10.1001\/jamanetworkopen.2021.22692","volume":"4","author":"JC Hojilla","year":"2021","unstructured":"Hojilla JC, et al. Characterization of HIV preexposure prophylaxis use behaviors and HIV incidence among US adults in an integrated health care system. JAMA Netw Open. 2021;4(8):e2122692\u20132122692.","journal-title":"JAMA Netw Open"},{"key":"12086_CR19","unstructured":"Krznaric I et al. HIV-Pr\u00e4vention f\u00fcr Frauen. HIV-Pr\u00e4expositionsprophylaxe in einer Deutschlandweiten nicht-m\u00e4nnlichen Kohorte. Frauenarzt 9\/2024, 2024."},{"key":"12086_CR20","doi-asserted-by":"crossref","unstructured":"Schmischke S, Kollan C, Schmidt D. HIV pre-exposure prophylaxis as a statutory health insurance service in Germany - A descriptive longitudinal claims data analysis (2019\u20132022). Deutsch-\u00d6sterreichischer-AIDS-Kongress (D\u00d6AK 2025), 2025.","DOI":"10.3389\/fpubh.2025.1586736"},{"issue":"11","key":"12086_CR21","doi-asserted-by":"publisher","first-page":"e756","DOI":"10.1016\/S2352-3018(24)00213-3","volume":"11","author":"NA Medland","year":"2024","unstructured":"Medland NA, et al. HIV incidence in people receiving government-subsidised pre-exposure prophylaxis in Australia: a whole-of-population retrospective cohort study. Lancet HIV. 2024;11(11):e756\u201364.","journal-title":"Lancet HIV"},{"key":"12086_CR22","unstructured":"Schmidt D, et al. Surveillance der versorgung Mit der HIV-Pr\u00e4expositionsprophylaxe in Deutschland \u2013 Ergebnisse der halbj\u00e4hrlichen befragung in HIV-Schwerpunkteinrichtungen. Epidemiologisches Bull, 2023. 7\/2023."},{"issue":"7","key":"12086_CR23","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1111\/hiv.13458","volume":"24","author":"N Fitzgerald","year":"2023","unstructured":"Fitzgerald N, et al. PrEP for women in Europe: a systematic literature review. HIV Med. 2023;24(7):765\u201376.","journal-title":"HIV Med"},{"key":"12086_CR24","doi-asserted-by":"publisher","unstructured":"Schmidt D. HIV-Pr\u00e4expositionsprophylaxe in Deutschland. hautnah dermatologie. 2023;39:38\u201343. https:\/\/doi.org\/10.1007\/s15012-023-7835-0.","DOI":"10.1007\/s15012-023-7835-0"},{"key":"12086_CR25","unstructured":"HIV-Pr\u00e4expositionsprophylaxe (PrEP): Potentiale entfalten - Versorgung sichern, verbessern und ausweiten. Stellungnahme & Forderungspapier des Community-Beirats im Projekt PrEP-Surv des Robert Koch-Instituts. 2023; Available from: https:\/\/www.aidshilfe.de\/sites\/default\/files\/documents\/stellungnahme_communityboard_final.pdf."},{"key":"12086_CR26","unstructured":"World Health Organization (WHO). Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance: technical brief. 2022."},{"issue":"4","key":"12086_CR27","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1007\/s10508-020-01903-8","volume":"50","author":"A Baldwin","year":"2021","unstructured":"Baldwin A, Light B, Allison WE. Pre-exposure prophylaxis (PrEP) for HIV infection in cisgender and transgender women in the US: a narrative review of the literature. Arch Sex Behav. 2021;50(4):1713\u201328.","journal-title":"Arch Sex Behav"},{"issue":"9","key":"12086_CR28","doi-asserted-by":"publisher","first-page":"3038","DOI":"10.1007\/s10461-024-04386-z","volume":"28","author":"C MacPhail","year":"2024","unstructured":"MacPhail C, et al. Ending HIV transmission in australia: expanding PrEP to cisgender women: a scoping review. AIDS Behav. 2024;28(9):3038\u201350.","journal-title":"AIDS Behav"},{"key":"12086_CR29","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1007\/s10461-019-02733-z","volume":"24","author":"JL Glick","year":"2020","unstructured":"Glick JL, et al. The PrEP care continuum among cisgender women who sell sex and\/or use drugs globally: a systematic review. AIDS Behav. 2020;24:1312\u201333.","journal-title":"AIDS Behav"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12086-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-12086-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12086-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:42:04Z","timestamp":1763059324000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-025-12086-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,13]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12086"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-12086-9","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,13]]},"assertion":[{"value":"7 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was submitted to the data protection officer and the institutional review board of the Robert Koch Institute. The Robert Koch Institute is the German national public health institute under the direction of the Federal Ministry of Health. The study was reviewed by the RKI data protection officer and the institutional review board, who raised no objections and approved its conduct (RKI 2022\u2009\u2212\u2009100). Although health-related data were collected, the survey was conducted anonymously without the collection of identifying information; therefore, in accordance with the General Data Protection Regulation (Regulation (EU) 2016\/679) and the guidelines of German ethics committees, a formal ethics vote was not required. All participants provided informed consent by completing the survey after reviewing the information on the introductory page. The study adhered to the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1574"}}