Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017–2020

INTRODUCTION: Accessibility of pre‐exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out‐of‐pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. METHODS: Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent‐driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self‐reported HIV‐negative/unknown GBM. RESULTS: Of 2008 self‐identified HIV‐negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4–31.4% (p<0.001) and Vancouver 21.7–59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60–2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68–1.18). CONCLUSIONS: Full free‐of‐charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.