{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T12:39:47Z","timestamp":1791722387681,"version":"4.3.4"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004726","name":"Ministry of Health","doi-asserted-by":"publisher","award":["ZMI1-2520AUK700"],"award-info":[{"award-number":["ZMI1-2520AUK700"]}],"id":[{"id":"10.13039\/501100004726","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004726","name":"Ministry of Health","doi-asserted-by":"publisher","award":["ZMI1-2521AUK700"],"award-info":[{"award-number":["ZMI1-2521AUK700"]}],"id":[{"id":"10.13039\/501100004726","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004726","name":"Ministry of Health","doi-asserted-by":"publisher","award":["ZMII2-2521AUK700"],"award-info":[{"award-number":["ZMII2-2521AUK700"]}],"id":[{"id":"10.13039\/501100004726","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Introduction of HIV pre-exposure prophylaxis (PrEP) into German statutory health insurance in September 2019 reduced barriers to an effective tool for HIV prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to provide a longitudinal analysis of HIV-PrEP care in a real-world setting in Germany between 09\/2019\u201308\/2023 using claims data from the insurance provider BARMER.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed anonymized claims data to analyze PrEP care and user characteristics. PrEP courses were defined and analyzed based on initiations, discontinuations and reinitiations, as well as proportion of days covered (PDC) as metric of adherence, post-exposure prophylaxis (PEP) and incident HIV infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 5,208 PrEP users with a median and average observation time of 1.3 and 1.7\u202fyears were identified, totaling to 8,822 person-years. By the end of observation 58% were active PrEP users and 43% were still on their first PrEP course. Median age was 34\u202fyears (IQR 28\u201343) and 98.6% were male. Median PDC was 91.3% (IQR 78.9\u201398.6%) for all observed courses. PrEP initiations increased again in 2022 after a decrease in 2020 and 2021. Of 267 PEP courses, 73.8% took place before PrEP initiation. HIV incidence rate was 0.07\/100 person-years. Out of the six detected HIV infections five occurred after PrEP discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall PrEP pill coverage was high and PrEP proved to be highly effective in preventing HIV. No stagnation or decline in PrEP uptake was observed, suggesting that PrEP needs in Germany are not yet fully covered. In 4\u202fyears of observation we saw a considerable number of PrEP discontinuations and reinitiations, which indicates that PrEP is utilized in accordance with specific user needs. Most PEP occurred before PrEP initiation, indicating that HIV risk was recognized which eventually led to PrEP prescription. We found a negative association between individuals\u2019 total PDC and length of PrEP use, suggesting need for interventions to increase adherence among long-term PrEP users. This study supports previous findings of high PrEP demand in men, assumingly mostly men who have sex with men and suggests that barriers to accessing PrEP and gaps in provision still exist, at least among non-males who would benefit from PrEP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1586736","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:26:10Z","timestamp":1762323970000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Exploring 4\u202fyears of HIV pre-exposure prophylaxis as a statutory health insurance benefit in Germany\u2014a longitudinal claims data analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Sandra","family":"Schmischke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kollan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Marschall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"ref1","year":"2023"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"320","DOI":"10.25646\/12212.2","article-title":"Sch\u00e4tzung der Anzahl von HIV-Neuinfektionen in den Jahren 2022 und 2023 sowie der Gesamtzahl der menschen, die Ende 2023 mit HIV in Deutschland leben [estimate of the number of new HIV infections in 2022 and 2023 and the total number of people living with HIV in Germany at the end of 2023 the total number of people living with HIV in Germany by the end of 2021]","volume":"28","author":"An Der Heiden","year":"2024","journal-title":"Epidemiol Bull"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25646\/11678","article-title":"Gemeldete HIV-Erstdiagnosen 2021-2022 [reported first-time HIV diagnoses 2021-2022]","volume":"35","author":"Marcus","year":"2023","journal-title":"Epidemiol Bull"},{"key":"ref4","year":"2016"},{"key":"ref5","year":"2016"},{"key":"ref6","year":"2019"},{"key":"ref7","year":"2020"},{"key":"ref8","first-page":"1","article-title":"Germany: health system review","volume":"22","author":"Bl\u00fcmel","year":"2020","journal-title":"Health Syst Transit"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25646\/11020","article-title":"Surveillance der Versorgung mit der HIV-Pr\u00e4expositionsprophylaxe in Deutschland \u2013 Ergebnisse der halbj\u00e4hrlichen Befragung in HIV-Schwerpunkteinrichtungen [surveillance of HIV pre-exposure prophylaxis care in Germany - results of the biannual survey in specialised HIV facilities]","volume":"7","author":"Schmidt","year":"2023","journal-title":"Epidemiol Bull"},{"key":"ref10","volume-title":"Abschlussbericht: Evaluation der Einf\u00fchrung der HIV-Pr\u00e4expositionsprophylaxe als Leistung der Gesetzlichen Krankenversicherung (EvE-PrEP) [Final report: Evaluation of the introduction of HIV pre-exposure prophylaxis as a statutory health insurance benefit (EvE-PrEP)]","author":"Schmidt","year":"2022"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.25646\/11624","article-title":"Surveillance der Versorgung mit der HIV-Pr\u00e4expositionsprophylaxe in Deutschland \u2013 Ergebnisse der zweiten halbj\u00e4hrlichen Befragung in HIV-Schwerpunkteinrichtungen","volume":"29","author":"Schmidt","year":"2023","journal-title":"Epidemiol Bull"},{"key":"ref12","author":"Schmidt","year":"2024"},{"key":"ref13","year":"2020"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"k3532","DOI":"10.1136\/bmj.k3532","article-title":"The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE)","volume":"363","author":"Langan","year":"2018","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e145","DOI":"10.1055\/s-0042-108647","article-title":"STandardisierte BerichtsROutine f\u00fcr Sekund\u00e4rdaten Analysen (STROSA) \u2013 ein konsentierter Berichtsstandard f\u00fcr Deutschland, Version 2. [STandardized Reporting Routine for Secondary Data Analysis (STROSA) - a consensus reporting standard for Germany]","volume":"78","author":"Swart","year":"2016","journal-title":"Gesundheitswesen"},{"key":"ref16","year":"2021"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e2122692","DOI":"10.1001\/jamanetworkopen.2021.22692","article-title":"Characterization of HIV Preexposure prophylaxis use behaviors and HIV incidence among US adults in an integrated health care system","volume":"4","author":"Hojilla","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/QAI.0000000000001129","article-title":"Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and 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