Implementation models and access to HIV pre-exposure prophylaxis in Spain.

To implement HIV pre-exposure prophylaxis (PrEP) in Spain, several possible models fitting the Spanish National Health System must be considered. The experience of other countries with a similar background let us foresee their benefits and their defects before implementing them. Possible implementation models for prescription-follow-up-dispensing circuits may involve hospitals, STI clinics or primary care centres and community pharmacies. On the one hand, a hospital-based circuit is the least effective of them all and it may not satisfy the potential demand, even though it could be deployed immediately. On the other hand, accessibility would increase with PrEP prescription in Primary care and dispensing by community pharmacists. Involvement of community-based STI clinics and publicly-funded STI clinics would be the best option to attract the population not frequenting the general health system, and co-management with Primary Care teams would ensure nation-wide access to PrEP.