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The preexposure prophylaxis revolution; from clinical trials to programmatic implementation.

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Investing in preexposure prophylaxis (PrEP) delivery is crucial for reducing HIV infections in Africa. Effective PrEP programs require policy integration and address population-specific risks for sustained public health impact.

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Area of Science:

  • Public Health
  • HIV Prevention
  • Epidemiology

Background:

  • Preexposure prophylaxis (PrEP) is a critical biomedical intervention for HIV prevention.
  • Sustainable delivery of PrEP requires robust policy frameworks and integration with existing HIV services.
  • Scaling up PrEP in Africa is essential given the high burden of new HIV infections on the continent.

Purpose of the Study:

  • To review key policy and programmatic considerations for the implementation and scale-up of PrEP in Africa.
  • To highlight the public health impact and sustainability of PrEP delivery strategies.
  • To discuss challenges and evidence for effective PrEP programs in real-world settings.

Main Methods:

  • Review of existing literature and demonstration project data on PrEP delivery.
  • Analysis of programmatic considerations including adherence, retention, and service delivery models.
  • Examination of barriers and facilitators to PrEP uptake and adherence in diverse African populations.

Main Results:

  • PrEP effectiveness in real-world settings exceeds that in randomized clinical trials, with high uptake, adherence, and retention observed.
  • Barriers to PrEP include stigma (especially among MSM) and low HIV risk perception (among young women).
  • Targeted interventions addressing population-specific risk drivers and optimal service delivery points are essential for successful PrEP programs.

Conclusions:

  • HIV prevention programs must integrate PrEP with interventions addressing social drivers of vulnerability.
  • Policy guidance on optimal intervention combinations, service delivery, and clinical protocols is needed.
  • Investment in advocacy and evidence generation on cost-effectiveness is crucial for widespread PrEP implementation in Africa to protect future generations.