Two young men who have sex with men (MSM) in Vietnam read a leaflet about HIV pre-exposure prophylaxis (PrEP) and available PrEP services.
Photo credit: PATH/Vu Ngoc Dung (with permission given from photographer for use)
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.
Per WHO recommendation, PrEP should be provided as part of a package of comprehensive prevention services that includes condom promotion, voluntary medical male circumcision, and 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 available) are vital interventions to prevent HIV.
HIV biomedical prevention research continues to evolve and innovate 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. Steps are already underway to plan for introduction and access for these new prevention modalities that have been developed while also looking forward to the incorporation of other products. These additional biomedical prevention products will provide a wider range of choices that can be tailored to client needs, ultimately resulting in further reduction of new HIV infections through expanded access to HIV prevention options.
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 1.5 million people on oral PrEP across 37 countries by the end of fiscal year 2022. 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 and decentralized drug dispensing.
- 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 demand creation 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 research, including to inform implementation of new biomedical prevention products.
In Fiscal Year 2022, USAID:
- Launched PrEP services in an additional six countries.
- Contributed to the initiation of more than 700,000 people on oral PrEP across 37 countries.
- Initiated over 225,000 members of key populations and over 275,000adolescent girls and young women ages 15-24 on PrEP.
PrEP Program Planning and Implementation Tools (see PrEPWatch)
- PrEP Planning Tools
- Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance
- HIV Prevention Ambassador Training Package and Toolkit
- Daily Oral PrEP, Event-Driven PrEP, PrEP Ring, and CAB PrEP Template Guidelines
- WHO recommends the dapivirine vaginal ring as a new choice for HIV prevention for women at substantial risk of HIV infection
- WHO Guidelines on Long-Acting Injectable Cabotegravir
Current and Recent USAID Partner Technical Assistance Support Activities
- Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC)
- Collaboration for HIV Prevention Options to Control the Epidemic (CHOICE)
- Optimizing Prevention Technology Introduction on Schedule (OPTIONS) Consortium
- Preparing for Ring Opportunities through Market Introduction Support and Knowledge Exchange (PROMISE)
- Reaching Impact, Saturation, and Epidemic Control (RISE)
- Meeting Targets and Maintaining Epidemic Control (EpiC)