Seoul launches ‘PrEP-invigorating pilot project’ to prevent new HIV infections

Amid public-private discussions on how to promote Pre-Exposure Prophylaxis (PrEP) to prevent new HIV infections, the Korea Disease Control and Prevention Agency (KDCA) said it would launch a pilot project to adjust the co-payment rate for PrEP drugs from the fourth quarter of this year.

Yoo Jung-hee, director of the AIDS Control Division at KDCA, unveiled the plan at the “Pride Expo PrEP Forum” organized by the Sinnaneun Center on July 7.

In addition to the KDCA, Professor Kim Tae-hyong of the Department of Infectious Diseases at Soon Chun Hyang University Hospital Seoul and Kim Hyun-goo, director of the LGBT AIDS Prevention Center at the Korea AIDS Federation, participated in the forum and held in-depth discussions on the topic of “Moves by government, private and medical sector needed to spread PrEP.”

The government has granted insurance benefits for PrEP targeting “sexual partners of people living with HIV” since 2019. As a result, applicants need to pay only 30-60 percent of the cost of PrEP drugs.

However, medical experts, including the Korean Society for AIDS, call for expanding the current coverage criteria to include MSM (men who have sex with men), a vulnerable group, in line with the society's recommendations (Recommendations for Pre-Exposure Prophylaxis for HIV in Korea, 2017).

According to the U=U (Undetectable=Untransmittable) concept, partners of infected individuals who are receiving appropriate treatment after diagnosis are far from being a vulnerable group, making the current PrEP coverage criteria ineffective, according to the experts.

Due to these restrictive coverage criteria and low access, annual use of PrEP remains virtually unchanged between pre- and post-coverage.

The problem is that there is not a lack of domestic demand for PrEP. According to the presentation at the forum, a significant number of people are using PrEP through illegal channels, including direct overseas purchases, internet purchases, and person-to-person deals, without prior testing and a prescription from medical professionals.

“To use PrEP safely, people should be tested for HIV, HBV, HCV, STIs, and other infections at a medical institution, and their kidney function should be evaluated before being prescribed PrEP,” Professor Kim said. “For example, there is a risk of developing resistant bacteria if an HIV-infected person uses PrEP.”

The two main barriers to PrEP use cited by the MSM community were cost and accessibility. Accordingly, the community suggested that realistic measures are needed to lower the cost burden on users and improve access to prescriptions.

In response, KGCA Director Yoo said that the agency plans to start a pilot project to adjust the co-payment rate for PrEP drugs in September or October and run it through the first half of next year. She explained this is part of the “Second Acquired Immunodeficiency Disease Prevention and Control Plan (2024-2028)” announced by the KCDC in March, in which the government set a plan to activate PrEP as a detailed task to prevent new infections.

“Through this pilot project, we will be able to identify the actual number of people who are currently outside the PrEP coverage, which can be back-estimated and ultimately used to determine the number of people in need of PrEP in Korea,” Yoo said.

By 2030, the KCDC aims to reduce the number of new HIV infections in Korea by 50 percent from 2023. Given the current average of about 1,000 new infections per year in the country, the goal is to cut that number in half by 2030.

To achieve this, KDCA has set a specific goal of increasing the number of PrEP users per year to 1,500 by 2028, starting with 550 in 2024.

However, critics argued that these are “low” targets that don't reflect reality and that there is no evidence to support them. They pointed out that the agency needs an estimate of the “PrEP need,” or the actual number of people at risk of HIV infection, to design effective prevention measures.

For example, in the United States, the number of people in need of PrEP is set at 1,216,210 for prevention policies. Without a specific number like this, it's unclear how much money will be spent to prevent HIV infection.

That, in turn, explains why experts have pointed out that the government should have conducted a policy service study to identify accurately the number of people in need of PrEP before announcing the prevention and control measures.

The experts noted that it would be interesting to see if the pilot project will be successful and produce data that can help the government identify the number of people in need of PrEP in Korea.