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Global Adoption of Guidelines on and Use of Oral Pre-Exposure Prophylaxis (PrEP): Current Situation and Future Projections

16 Pages Posted: 1 Mar 2021

See all articles by Robin Schaefer

Robin Schaefer

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Heather-Marie Schmidt

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Giovanni Ravasi

Pan American Health Organization

Antons Mozalevskis

World Health Organization (WHO) - Regional Office for Europe

Bharat B. Rewari

World Health Organization (WHO) - Regional Office for South-East Asia

Frank Lule

World Health Organization (WHO) - Regional Office for Africa

Kouadio Yeboue

World Health Organization (WHO) - Regional Office for Africa

Anne Brink

World Health Organization (WHO) - Regional Office for the Western Pacific

Nabeel Mangadan Konath

World Health Organization (WHO) - Regional Office for South-East Asia

Mukta Sharma

World Health Organization (WHO) - Regional Office for South-East Asia

Nicole Seguy

World Health Organization (WHO) - Regional Office for Europe

Joumana Hermez

World Health Organization (WHO) - Regional Office for the Eastern Mediterranean

Ahmed Sabry Alaama

World Health Organization (WHO) - Regional Office for the Eastern Mediterranean

Naoko Ishikawa

World Health Organization (WHO) - Regional Office for the Western Pacific

Boniface Dongmo Nguimfack

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Daniel Low-Beer

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Rachel Baggaley

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Shona Dalal

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

More...

Abstract

Background: With the 2020 global target of three million oral pre-exposure prophylaxis (PrEP) users set during the UN General Assembly in 2016 at an end, we assessed global trends in the adoption of World Health Organization (WHO) PrEP recommendations into national guidelines and numbers of PrEP users, and estimated future trajectories of PrEP users. 

Methods: Data obtained through the Global AIDS Monitoring (GAM) and WHO regional offices was collated to report numbers of PrEP users and WHO PrEP recommendations adoption by country for 2016-2019. To forecast PrEP user numbers until 2023, model countries were selected in each region. PrEP use growth rates observed in these model countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. 

Findings: In 2019, there were 630,000 PrEP users across 76 countries (41% in Americas and 36% in African region), a 70% increase from 2018. 121 countries had adopted the WHO PrEP recommendations in national guidelines: 33 countries in 2018 and 23 in 2019. Without COVID-19 disruptions, 1·0-1·1 million global PrEP users by the end of 2020 and 2·4-5·2 million by 2023 were projected. If COVID-19 disruptions result in no PrEP user growth in 2020, there would be 0·7-1·6 million fewer PrEP users in 2023 (vs. no disruptions). 

Interpretation: Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. While the 2020 global PrEP target will be missed, we estimated future growth in PrEP use. In many countries, PrEP user numbers are small relative to new HIV infections and PrEP recommendations are not implemented at scale. New PrEP products could expand the PrEP user base and, with greater oral PrEP use through simplified delivery, PrEP could significantly contribute to ending AIDS by 2030. 

Funding Statement: We thank Unitaid for providing the funding necessary to this work.

Declaration of Interests: The authors declare no conflict of interests.

Suggested Citation

Schaefer, Robin and Schmidt, Heather-Marie and Ravasi, Giovanni and Mozalevskis, Antons and Rewari, Bharat B. and Lule, Frank and Yeboue, Kouadio and Brink, Anne and Mangadan Konath, Nabeel and Sharma, Mukta and Seguy, Nicole and Hermez, Joumana and Alaama, Ahmed Sabry and Ishikawa, Naoko and Nguimfack, Boniface Dongmo and Low-Beer, Daniel and Baggaley, Rachel and Dalal, Shona, Global Adoption of Guidelines on and Use of Oral Pre-Exposure Prophylaxis (PrEP): Current Situation and Future Projections. Available at SSRN: https://ssrn.com/abstract=3788127 or http://dx.doi.org/10.2139/ssrn.3788127

Robin Schaefer (Contact Author)

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme ( email )

Geneva
Switzerland

Heather-Marie Schmidt

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme ( email )

Geneva
Switzerland

Giovanni Ravasi

Pan American Health Organization ( email )

Washington, DC
United States

Antons Mozalevskis

World Health Organization (WHO) - Regional Office for Europe ( email )

8, Scherfigsvej
DK-2100
Copenhagen

Bharat B. Rewari

World Health Organization (WHO) - Regional Office for South-East Asia ( email )

New Delhi
India

Frank Lule

World Health Organization (WHO) - Regional Office for Africa ( email )

Brazzaville
Congo, Republic of

Kouadio Yeboue

World Health Organization (WHO) - Regional Office for Africa ( email )

Brazzaville
Congo, Republic of

Anne Brink

World Health Organization (WHO) - Regional Office for the Western Pacific ( email )

PO Box 2932
1000 Manila
Philippines

Nabeel Mangadan Konath

World Health Organization (WHO) - Regional Office for South-East Asia ( email )

New Delhi
India

Mukta Sharma

World Health Organization (WHO) - Regional Office for South-East Asia ( email )

New Delhi
India

Nicole Seguy

World Health Organization (WHO) - Regional Office for Europe ( email )

8, Scherfigsvej
DK-2100
Copenhagen

Joumana Hermez

World Health Organization (WHO) - Regional Office for the Eastern Mediterranean ( email )

Abdul Razzak Al Sanhouri Street
P.O. Box 7608
Nasr City, Cairo 11371
Egypt

Ahmed Sabry Alaama

World Health Organization (WHO) - Regional Office for the Eastern Mediterranean ( email )

Abdul Razzak Al Sanhouri Street
P.O. Box 7608
Nasr City, Cairo 11371
Egypt

Naoko Ishikawa

World Health Organization (WHO) - Regional Office for the Western Pacific ( email )

PO Box 2932
1000 Manila
Philippines

Boniface Dongmo Nguimfack

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme ( email )

Geneva
Switzerland

Daniel Low-Beer

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme ( email )

Geneva
Switzerland

Rachel Baggaley

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme

Geneva
Switzerland

Shona Dalal

World Health Organization (WHO) - Global HIV, Hepatitis and STI Programme ( email )

Geneva
Switzerland

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