With no expected vaccine for HIV in the near future, we aimed to define the current situation and challenges for pre- and post-exposure prophylaxis (PrEP and PEP) in Central and Eastern Europe (CEE). The Euroguidelines CEE Network Group members were invited to respond to a 27-item survey including questions on PrEP (response rate 91.6%). PrEP was licensed in 68.2%; 95 centers offered PrEP and the estimated number on PrEP was around 9000. It was available in daily (40.1%), on-demand (13.3%), or both forms (33.3%). The access rate was <1−80%. Three major barriers for access were lack of knowledge/awareness among people who are in need (59.1%), not being reimbursed (50.0%), and low perception of HIV risk (45.5%). Non-occupational PEP was available in 86.4% and was recommended in the guidelines in 54.5%. It was fully reimbursed in 36.4%, only for accidental exposures in 40.9%, and was not reimbursed in 22.72%. Occupational PEP was available in 95.5% and was reimbursed fully. Although PrEP scale-up in the region has gained momentum, a huge gap exists between those who are in need of and those who can access PrEP. Prompt action is required to address the urgent need for PrEP scale-up in the CEE region.

4th Department of Internal Medicine Medical School National and Kapodistrian University of Athens University General Hospital ATTIKON 12462 Athens Greece

Astar Medical Center 79054 Lviv Ukraine

Center for Communicable Disease Control and Prevention Institute for Public Health of Montenegro 81000 Podgorica Montenegro

Center for Treatment of HIV AIDS Patients Department of Infectology and Geographical Medicine Academic L Derer's University Hospital 2412 Bratislava Slovakia

Clinic for Infectious Diseases Clinical Center University of Sarajevo 71000 Sarajevo Bosnia and Herzegovina

Clinic for Infectious Diseases University Clinical Center of the Republic of Srpska 78000 Banja Luka Bosnia and Herzegovina

Department for AIDS Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases Sofia Medical University Sofia 1431 Sofia Bulgaria

Department of Adults' Infectious Diseases Hospital for Infectious Diseases Medical University of Warsaw 01 201 Warsaw Poland

Department of AIDS Epidemiology and Prevention Central Research Institute of Epidemiology Federal AIDS Centre 111123 Moscow Russia

Department of HIV and Tropical Diseases South Pest Central Hospital National Institute of Hematology and Infectious Diseases 1097 Budapest Hungary

Department of Infectious Disease Faculty of Medicine University Hospital Center of Tirana 1001 Tirana Albania

Department of Infectious Diseases and Clinical Microbiology Medical Faculty Ege University Izmir 35100 Türkiye

Department of Infectious Diseases and Dermatovenerology Vilnius University Hospital Santaros Klinikos Vilnius University LT 08410 Vilnius Lithuania

Department of Infectious Diseases School of Medicine University of Zagreb 10000 Zagreb Croatia

Department of Infectious Diseases Tartu University Hospital 50406 Tartu Estonia

Department of Infectious Diseases University Medical Center Ljubljana 1525 Ljubljana Slovenia

Department of Pharmacology Clinical Pharmacology and Toxicology School of Medicine University of Belgrade 11000 Belgrade Serbia

Department of Virology National Center of Infectious and Parasitic Diseases 1504 Sofia Bulgaria

Global Fund Grant Management Department Republican Scientific and Practical Center of Medical Technologies Informatization Management and Economics of Public Health 220013 Minsk Belarus

HIV AIDS Research and Practice Center Ege University Izmir 35100 Türkiye

HIV Center University Hospital Charles University 11000 Pilsen Czech Republic

HIV Out Patient Clinic Hospital for Infectious Diseases Medical University of Warsaw 01 201 Warsaw Poland

Infectious Diseases AIDS and Clinical Immunology Research Center 0160 Tbilisi Georgia

Internal Medicine Department Erasmus MC 2040 3000 Rotterdam The Netherlands

National Center for Disease Control and Prevention Yerevan 0025 Armenia

University Clinic for Infectious Diseases and Febrile Conditions Skopje Faculty of Medicine Skopje Ss Cyril and Methodius University 1010 Skopje North Macedonia

Victor Babes Hospital for Infectious and Tropical Diseases Carol Davila University of Medicine and Pharmacy 030303 Bucharest Romania

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