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The evolution of oral PrEP access: tracking trends in global oral PrEP use over time

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BACKGROUND: Since oral pre-exposure prophylaxis (PrEP) was approved for HIV prevention in 2012, 78 countries have begun offering PrEP in some form. Measuring progress against global targets and sharing strategies across countries are critical to driving impact. Since 2014, AVAC has collected data from PrEP programs to track and generate insights on PrEP implementation.
METHODS: The Global PrEP Tracker is a comprehensive database of PrEP projects and national programs. Data are collected through a quarterly survey to 253 programs, and include PrEP initiation numbers, geography, and other indicators. This analysis examined data from Quarter 3 (Q3) 2016 to Q2 2020 to highlight global and regional PrEP initiation trends.
RESULTS: Global PrEP uptake has increased six-fold in approximately four years, from 102,446 initiations in 2016 to 651,586 in 2020. Annual growth has slowed over time, from 104% from 2017-2018, to 55% from 2018-2019, to 18% from 2019-2020. At the regional level, Oceania has the highest rate of change, with total PrEP initiations increasing from 318 to 29,093, driven largely by Australia. Sub-Saharan Africa has substantially expanded PrEP access, from 4,154 initiations in 2016 to 290,981 by mid-2020, comprising 44% of the global total. South Africa and Kenya have led this growth, counting 69,876 and 63,000 cumulative initiations, respectively. Brazil is leading PrEP uptake in Latin America and the Caribbean, accounting for two-thirds of initiations, and Thailand comprises 51% of initiations in Asia. The United States has the most cumulative initiations at 203,837, about one-third of the global total, but has comparatively modest growth rates. Shared traits in many of these settings are early adoption, national commitment to scale-up, and programs tailored to populations at high risk offering rights-based services and linkages to social support.
CONCLUSIONS: While PrEP initiations have grown exponentially in several countries, global uptake falls far short of UNAIDS' target of 3 million users, indicating a need for sustained demand creation where PrEP programs exist, and scale-up where PrEP is provided via demonstration projects with limited reach. Countries should replicate successful approaches, including service delivery models that meet end users' needs, to achieve notable reductions in new HIV infections.