Just how far off target are we? Measuring unmet pre-exposure prophylaxis need among men who have sex with men and transgender women in Asia-Pacific

BACKGROUND: Oral HIV pre-exposure prophylaxis (PrEP) uptake in the Asia-Pacific region is sub-optimal with only 2% of the 2025 goal of PrEP use achieved in 2023. There is no agreed-on measure of unmet PrEP need, and no assessment of unmet need across the Asia-Pacific. METHODS: We surveyed men who have sex with men (MSM) and transgender women (TGW) in 15 Asian countries and Australia (16 total). We defined unmet PrEP need as those who had: (1) heard of and wanted to take PrEP, but never taken it; (2) never heard of PrEP but had HIV risk factors; (3) taken oral PrEP but preferred a different PrEP product; or (4) temporarily discontinued oral PrEP due to a barrier. Descriptive statistics and multivariable logistic regression models identifed factors associated with unmet PrEP need. RESULTS: Among 17,032 MSM and 1260 TGW surveyed, 59.9% MSM and 47.5% TGW had unmet PrEP need. The most common unmet PrEP need was being PrEP-naïve but wanting to take PrEP (55.6% MSM; 31.2% TGW), followed by being a current oral PrEP user but preferring to use a different product (18.2% MSM; 28.1% TGW), being unaware of PrEP but reporting risk factors indicative of PrEP need (12.4% MSM; 20.7% TGW), and temporarily discontinued PrEP due to a barrier to accessing services (13.8% MSM; and 19.9% TGW). CONCLUSIONS: Unmet need is a critical measure of PrEP access, uptake, and coverage. Unmet PrEP need in Asia-Pacific is exacerbated by funding cuts from international donors. Urgent action is needed to increase PrEP access to achieve its goal of ending HIV by 2030.