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Global implementation of PrEP for HIV prevention: setting expectations for impact.
Maria N Pyra1,2, Jessica E Haberer3,4, Nina Hasen5
1Department of Global Health, University of Washington, Seattle, WA, USA.
Journal of the International AIDS Society
|August 29, 2019
Summary
HIV pre-exposure prophylaxis (PrEP) can reduce population-level HIV incidence if uptake, adherence, and persistence targets are met. Focusing on high-risk groups and normalizing PrEP use are key to its success as a public health intervention.
Area of Science:
- Public Health
- Epidemiology
- HIV Prevention
Background:
- The effectiveness of HIV pre-exposure prophylaxis (PrEP) as a public health intervention is under evaluation.
- Understanding PrEP's impact on population-level HIV incidence requires examining uptake, adherence, and persistence.
Purpose of the Study:
- To discuss expectations for PrEP uptake, adherence, and persistence.
- To analyze the combined impact of these factors on the HIV epidemic.
- To provide insights for successful public health implementation of PrEP.
Main Methods:
- Comparative analysis using examples from HIV treatment and contraceptive interventions.
- Discussion of measurable processes for improved coverage and reduced HIV incidence.
Main Results:
- PrEP uptake targets should be tailored to local HIV epidemics and at-risk populations.
- While daily adherence is ideal, perfect adherence should not be a prerequisite for use.
- Persistence on PrEP is crucial for sustained protection as long as individuals remain at risk.
Conclusions:
- Uptake, adherence, and persistence are critical, measurable processes for PrEP implementation.
- Focusing PrEP coverage on high-risk populations enhances its effectiveness.
- Normalizing PrEP use, rather than stigmatizing it, is essential for widespread success.
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