Public health perspective on HIV prevention and care in Italy: from innovation to system impact

Issue

Despite major advances in HIV treatment and prevention, public health systems face persistent gaps in translating effective interventions into population-level impact. In Italy, 2,379 new HIV diagnoses were reported in 2024 (4/100.000), with mostly sexual transmission and a high proportion of late diagnosis. Late diagnosis reflects clinical delay and organizational and social barriers. Ensuring fair access to testing, prevention and care is then a public health priority across European settings.

Description

This work presents a public health framework developed in Italy (2023-2026) focusing on three pillars: combined prevention, professional training and system sustainability. It combines epidemiological data, European standards (ECDC/EACS) and recent policy changes. This approach aims to: reduce late diagnosis; improve access to testing and PrEP; strengthen adherence, retention, and re-engagement; ensure sustainable, integrated service delivery across settings.

Results

Evidence shows that combined prevention improves early diagnosis and reduces transmission. However, in Italy and Europe, late diagnosis is still high (48-54% of new diagnoses). Thus introduction of reimbursed PrEP and long-acting prevention expands opportunities but requires new organizational models. Multidisciplinary interventions are associated with improved adherence (OR≈2.7) and viral suppression (OR≈4.1), although evidence quality is moderate.

Lessons

Effective HIV control needs to shift from isolated interventions to integrated, person-centred systems. Key actions include expanding testing in clinical and community settings and also PrEP access, strengthening multiprofessional training and remodeling care pathways to improve retention and re-engagement. Sustainability should be reframed from cost containment to value generation through early diagnosis, prevention and continuity of care. These lessons are transferable to other European countries facing similar challenges.

Key messages

• Effective HIV tools exist, but impact depends on fair access and integrated delivery systems.

• Reducing late diagnosis and improving retention are the key to a sustainable HIV control.