Missed opportunities to prevent HIV acquisition with pre‐exposure prophylaxis: A mixed methods study of people with recently acquired HIV in the United Kingdom

Objectives To explore missed opportunities for PrEP use among people with recently acquired HIV in the United Kingdom. Methods Data were derived from CASCADE, an international, longitudinal, mixed‐methods study of adults (≥16 years) with recently acquired HIV (≤12 months). Individuals were recruited from nine UK clinics (08/2022–09/2024) to self‐complete a questionnaire; a subset participated in semi‐structured interviews (SSIs). Results 46 questionnaires were completed (39 cisgender men and 7 women, including 2 transgender women) and 11 SSIs (1 cisgender woman). Among men, 22 perceived HIV risk before diagnosis; 21 had ≥5 sexual partners and 17 reported group sex in the 3 months before diagnosis. Thirty (29 men and 1 woman) reported sexualized drug use. Twenty men had ever used PrEP; seven of them had not used it in the 6 months prior to diagnosis. No women had ever used PrEP. Most gay, bisexual and other men who have sex with men (GBMSM) were aware of PrEP; however, risk perception, social meanings of PrEP and concerns about side effects hindered utilization. Among five men using event‐based dosing (EBD), three described difficulty predicting sexual activity that led to missed or mistimed pre−/post‐sex doses – while others were reluctant to take daily PrEP. For women, the biggest barrier was lack of awareness. Conclusions PrEP barriers vary by population. For GBMSM, addressing barriers to uptake/adherence (e.g., EBD challenges) are key, highlighting the potential benefit of long‐acting injectables. However, awareness of PrEP remains a key challenge for women to achieve equity in prevention.