USAID's investments, through PEPFAR, support innovative programming that ensures person-centered access to quality PrEP services.

Pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by people who do not have HIV to prevent HIV. Studies have shown that oral PrEP significantly reduces the likelihood of acquiring HIV and, following the World Health Organization (WHO) guidelines, should be offered to those at substantial risk of HIV infection.

According to the WHO recommendation, PrEP should be provided as part of a package of comprehensive prevention services that include condom promotion and voluntary medical male circumcision, as well as structural interventions, aimed at influencing social, political, or economic environments to reduce vulnerability to HIV infection. As a core component in this prevention package, oral PrEP (and new PrEP products as they become available) are vital interventions to prevent HIV.

HIV biomedical prevention research continues to evolve to support the development, introduction, and implementation of new forms of PrEP. For example, in July 2021, the WHO recommended the dapivirine vaginal ring (DPV-VR), and in July 2022, the long-acting injectable cabotegravir (CAB-LA) as additional HIV prevention options for people at substantial risk of HIV infection. Additional new products are currently in development. Steps are already underway to introduce new prevention modalities that have been developed. These additional biomedical prevention products provide a wider range of options that can be tailored to client needs, resulting in the reduction of new HIV infections.

Our Approach and Results

Since 2017, USAID has supported the implementation of PrEP. USAID, through PEPFAR, supports innovative programming that ensures person-centered access to quality PrEP services by those who may benefit most, and contributed to the initiation of more than 1 million people on oral PrEP across 42 countries by the end of fiscal year 2023. USAID works in close collaboration with host country governments, other U.S. Government agencies, multilateral and bilateral donors, the private sector, and implementing partners to provide support to PrEP scale-up through:

  • Technical assistance for program design, implementation, and monitoring and evaluation.

  • Technical assistance for policy, strategic, and operational plan development, including creation of PrEP clinical guidelines and standard operating procedures.

  • Service delivery, including knowledge expansion and demand creation, human resources for health, and innovations such as multi-month dispensing (MMD), decentralized drug dispensing (DDD) and sexual and reproductive health services. 

  • Identification and sharing of best practices and support for regional learning exchange, including through the use of virtual multi-country platforms such as the Global PrEP Learning Network.

  • Development and implementation of social and behavior change strategies and materials as well as provider training for PrEP and new products.

  • Commodity procurement and logistics management, including forecasting and distribution.

  • Introduction and access to research, including to inform implementation of new biomedical prevention products.

In 2023, USAID's efforts have led to achievements in the following areas:

  • Launched PrEP services in an additional five countries: El Salvador, Honduras, Jamaica, Papua New Guinea, and South Sudan.

  •  Supported more than one million people across 42 countries to start PrEP for HIV prevention. USAID’s local partners supported almost 683,000 of those people, representing 68 percent of all USAID-supported people starting PrEP. 

  • Supported the introduction and scale-up of long-acting PrEP (called CAB-LA) by training 80 government leaders, implementing partners, and other key country stakeholders in eight countries in Africa; this was the first-ever training for delivery of CAB-LA outside of a research study setting. 

  • Initiated over 275,000 members of key populations and over 375,000 adolescent girls and young women aged 15-24 on PrEP.