HIV pre-exposure prophylaxis: scaling up for impact now and in the future

Abstract

More than a decade after the first efficacy evidence for oral HIV pre-exposure prophylaxis (PrEP) was reported, PrEP uptake globally has been inadequate and global HIV prevention targets have been missed. Access to PrEP is still highly concentrated in a fairly small number of countries and, even within countries with widespread PrEP access, inequalities have emerged. More ambitious, high-priority global targets for PrEP uptake are required and could accelerate the HIV prevention response in a similar way to the success of the 90-90-90 testing and treatment targets. Health systems must be PrEP-friendly and allow PrEP to be prescribed in settings already attended by large numbers of HIV-negative individuals who are at risk. Several models have been advanced for the greater demedicalisation of PrEP. Individual-level barriers to PrEP uptake and persistence have been characterised, such as low awareness, low willingness to use PrEP, and the gap between self-perceived and actual HIV risk. Overcoming these barriers will require further efforts to understand and address them first. New PrEP modalities are emerging; as more options become available, we need to develop a greater understanding of the long-term patterns of PrEP use in different populations and to develop models of such use that can accommodate people alternating through periods of use and non-use, as well as switching between dosing regimens or modalities as they become available. Scaling up PrEP is crucial to achieving the UNAIDS prevention targets for 2030. Simply getting more people onto PrEP cannot be the only goal: the big-picture definition of success for PrEP programmes must be their impact on the HIV epidemic.

Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study

“…3 , 4 Although global targets for PrEP coverage vary, UNAIDS recommends 50% coverage for MSM and transgender people at very high risk of acquiring HIV. 4 , 5 …”

Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

“…A recent publication from Bavinton and Grulich (66) clearly highlights the importance of contextualizing the new PrEP modalities that have emerged and are emerging, reinforcing the need to better understand the long-term patterns of PrEP use in different target populations and developing models of use by these individuals, alternating through "periods of use and non-use, as well as switching between dosing regimens or modalities as they become available" (66).…”

“…Ending HIV must remain in the political, societal and health agendas around the world and we, members of modern societies, should not have any doubts about who is at risk for infection of HIV and to whom scaling up of PrEP is a crucial step. Better use of the already available tools is in order, PrEP is one of the most promising interventions Europe should aim for given the intrinsic potential for impacting the HIV epidemic (66).…”

Delivering HIV pre-exposure prophylaxis (PrEP) care online: A scoping review

“…[5,6] The UNAIDS 2020 HIV prevention road map states that a lack of systematic implementation of HIV prevention methods at scale is slowing efforts to reach targets. [7][8][9]. Only one third of the target 3 million people had started PrEP by the end of 2020.…”

“…Only one third of the target 3 million people had started PrEP by the end of 2020. [7,9] PrEP provision (PrEP care) involves several elements of care: baseline testing for HIV and other blood borne viruses, sexually transmitted infection (STI) screening as appropriate, renal function assessment, and prescribing of a fixed formulation of antiviral drugs, most commonly tenofovir disoproxil and emtricitabine. [10,11] Regular monitoring is recommended in many countries' guidelines and includes adherence support, repeat infection screening, and renal function monitoring.…”