Infectious Disease

HIV-PrEP uptake has elevated six-fold in Four years and nonetheless falls below world targets

January 26, 2021

3 min read

Source / information

Segal K et al. Abstract 1346. Presented at: HIV Research for Prevention; 27.-28. January and 3-4. February 2021 (virtual meeting).

Segal does not report any relevant financial information.


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The uptake of HIV-PrEP has increased six-fold worldwide in the last 4 years, but falls short of the UNAIDS target of 3 million users. This is based on data reported during the HIV Research for Prevention virtual conference.

Kate Segal, MA, The staff who manage product launch and access at AVAC, the nonprofit advocacy group, AVAC, and colleagues used data from the AVAC Global PrEP Tracker to assess trends in global and regional PrEP initiation.

PrEP pill

The uptake of HIV-PrEP has increased sixfold worldwide in the last 4 years. However, the researchers assume that global acceptance will not reach the UNAIDS target of 3 million users.
Photo credit: Adobe Stock

According to Segal, AVAC has maintained the tracker – an open access database of PrEP programs – since 2014. The tracker “is a tool that can be used to keep track of ongoing implementation and advocacy efforts,” Segal told Healio.

“AVAC collects and aggregates data for snapshots on a global and country level. For each country, we provide details on the types of ongoing programs, target groups, project areas, number of initiations, Truvada approval status and generic PrEP for prevention more, ”she said. “By tracking these metrics, we were able to determine which countries PrEP is scaling in and learn lessons from the implementation that can be more widely applied.”

Kate Segal

Slow growth

For their study, Segal and colleagues examined data from the third quarter of 2016 to the second quarter of 2020. They found that the total global PrEP intake increased from 102,446 initiations in 2016 to 651,586 in 2020. However, annual growth slowed over time from 104% from 2017-2018 to 55% from 2018-2019 to 18% from 2019-2020.

At the regional level, Oceania had the highest rate of change, with the total number of PrEP initiations increasing from 318 to 29,093 – an increase mainly due to admission in Australia, Segal and colleagues said. Sub-Saharan Africa has significantly expanded PrEP access from 4,154 initiations in 2016 to 290,981 by mid-2020, accounting for 44% of the global total, the researchers said. That growth was driven by South Africa and Kenya with 69,876 and 63,000 cumulative initiations, respectively, according to the data.

Segal and colleagues reported that Brazil tops PrEP intake in Latin America and the Caribbean with two-thirds of initiations, while Thailand accounts for 51% of initiations in Asia.

Segal said the single biggest thing that could increase PrEP uptake globally is to make it widely available and let people know it exists.

“PrEP has been introduced into populations that have been classified as high-risk, thus stigmatizing the product that stigmatization programs are now working to reduce,” she said. “Making it available to the general population while adapting the range to suit environments and populations with high levels of HIV can help normalize.”

She said that providing PrEP in a variety of service delivery channels would also help improve access.

“In many places, PrEP is mainly available from healthcare facilities that provide HIV services. Expanding the delivery models that bring PrEP closer to the user, including mobile clinics, community-based services, integrated HIV and sexual reproductive health services, youth-friendly services, multi-month dispensing, and mobile health, make it easier for PrEP users to integrate it into their lives ”, she said. “We have seen a shift towards these models in response to COVID-19. Maintaining them will be important in maintaining access. “

The United States had the most cumulative initiations at 203,837 – about a third of the world’s total, although the country had “comparatively modest growth rates,” noted Segal and colleagues.

Segal said there is a divide in the US between the epidemiology of new HIV infections and access to PrEP, which she believes is underpinned by geographic and racial inequalities. In that regard, she said the cost of PrEP services and the complexity of navigating the US healthcare system are major barriers to entry, especially for communities where the HIV epidemic is concentrated, including among black and Latin American men who have sex with Men have and in the South, where more than half of all new HIV diagnoses in the US occur.

Address stigma

Globally, Segal said that access and cost are just big pieces of the puzzle, not the only ones. The reasons people stop using PrEP also need to be addressed. There are many reasons for this, according to Segal, including a change in HIV risk, a preference for a different method of prevention, and stigma. Programs and interventions to support PrEP users who wish to continue using it are “critical” in removing these barriers, particularly the stigma, she said.

“While it is difficult to quantify the impact of stigma on global uptake of PrEP, it cannot be denied that prevention programs in general – and PrEP programs in particular – grapple with the stigma of having one pill every day for HIV prevention to take, “said Segal. “There tends to be fear of being linked to HIV, whether it be the rattle of a pill bottle, the color of PrEP tablets, or being seen by neighbors in a clinic’s HIV department, so users may prefer services and products that are discreet and discreet are camouflaged. Vendor stigma was also an issue. For example, teenage girls and young women may feel judged by providers preventing them from using HIV prevention services. “


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