Global implementation of PrEP for HIV prevention: setting expectations for impact

Introduction Questions remain whether HIV pre‐exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population‐level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence,...

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Bibliographic Details
Published in:Journal of the International AIDS Society 2019-08, Vol.22 (8), p.e25370-n/a
Main Authors: Pyra, Maria N, Haberer, Jessica E, Hasen, Nina, Reed, Jason, Mugo, Nelly R, Baeten, Jared M
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adherence
Adult
AIDS
Anti-HIV Agents - administration & dosage
Anti-HIV Agents - therapeutic use
Clinical trials
Contraceptive Agents
Disease prevention
Female
HIV
HIV infection
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV prophylaxis
Human immunodeficiency virus
Humans
Implementation
Incidence
Infections
Male
Medication Adherence
Pharmacy
Population
Pre-Exposure Prophylaxis - statistics & numerical data
Prevention
Regulatory approval
Retention
Risk Factors
Studies
Success
Uptake
Womens health
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Summary:Introduction Questions remain whether HIV pre‐exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population‐level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. Discussion Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event‐driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high‐risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. Conclusions While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.
ISSN:1758-2652
1758-2652
DOI:10.1002/jia2.25370