Impact of antiretroviral shortages in HIV therapy and prevention uptake in Australia

Human immunodeficiency virus (HIV) remains a major public health priority in Australia, with treatment and prevention efforts underpinned by access to government-subsidised antiretroviral therapy (ART) through the Pharmaceutical Benefits Scheme (PBS). In 2023-2024, multiple tenofovir with emtricitabine products used for HIV treatment and pre-exposure prophylaxis (PrEP) were subject to national shortages, raising concerns about access and continuity of care. This study aimed to examine changes in monthly PBS dispensings of tenofovir with emtricitabine before, during and after the reported shortages, and assess potential impacts on HIV diagnostic testing behaviour. Using publicly available aggregated PBS and Medicare Benefits Schedule (MBS) data from January 2023 to December 2024, we quantified trends in ART and PrEP dispensings alongside HIV test claims. We found a 42% reduction in PrEP dispensing during the shortage period, with a notable decline across all PBS-listed PrEP products. Despite the approval of an overseas-registered Section 19A product in October 2024, PrEP dispensing did not return to pre-shortage levels. Diagnostic testing volumes remained relatively consistent across the study period. These findings suggest that HIV prevention efforts may be sensitive to medicine shortages and underscore the value of timely regulatory responses to help maintain access to essential medicines.