A National Multidisciplinary Consensus to Develop an HIV Pre-Exposure Prophylaxis (PrEP) Referral Framework in Romania

Background: Despite major advances in antiretroviral therapy, HIV transmission remains an important public health challenge. Pre-exposure prophylaxis (PrEP) is a highly effective prevention strategy, offering a significant opportunity to further reduce new HIV infections through expanded access and optimized implementation. Methods: A national multidisciplinary consensus process was conducted to define principles and operational pathways for PrEP referral and linkage in Romania. Experts from different medical fields, professional societies, academic institutions, and community-based organizations participated in structured discussions. Results: The consensus highlighted relevant knowledge gaps related to HIV prevention and PrEP among specialists working outside the field of infectious diseases, including difficulty recognizing risk factors for HIV, uncertainty about next steps after identifying risk factors, and uneasiness discussing sexual health. The consensus also emphasized a shared commitment of these professional societies to address these gaps through pragmatic, specialty-adapted training. Key priorities included improved HIV risk recognition in routine care, development of communication skills, and clear referral pathways to PrEP services. Existing barriers were also discussed, underscoring the importance of multidisciplinary networks and community engagement. Conclusions: This consensus provides a structured, context-adapted framework to support the upcoming nationwide implementation of PrEP in Romania. By strengthening provider education, clarifying clinical pathways, and fostering interdisciplinary collaboration, it offers a foundation for equitable and sustainable HIV prevention.