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Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy.

Publication ,  Journal Article
Cáceres, CF; Borquez, A; Klausner, JD; Baggaley, R; Beyrer, C
Published in: J Int AIDS Soc
2016

BACKGROUND: In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. DISCUSSION: The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives. Those guidelines present a timely challenge to health systems for the scaling up of not only treatment for every person living with HIV infection but also the offer of PrEP to those at substantial risk. Delivery and uptake of both universal antiretroviral therapy (ART) and PrEP will require nation-wide commitment and could reinvigorate health systems to develop more comprehensive "combination prevention" programmes and support wider testing linked to both treatments and other prevention options for populations at highest risk who are currently not accessing services. Various gaps in current health systems will need to be addressed to achieve strategic scale-up of PrEP, including developing prioritization strategies, strengthening drug regulations, determining cost and funding sources, training health providers, supporting user adherence and creating demand. CONCLUSIONS: The initial steps in the scale-up of PrEP globally suggest feasibility, acceptability and likely impact. However, to prevent setbacks in less well-resourced settings, countries will need to anticipate and address challenges such as operational and health systems barriers, drug cost and regulatory policies, health providers' openness to prescribing PrEP to populations at substantial risk, demand and legal and human rights issues. Emerging problems will require creative solutions and will continue to illustrate the complexity of PrEP implementation.

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Published In

J Int AIDS Soc

DOI

EISSN

1758-2652

Publication Date

2016

Volume

19

Issue

7(Suppl 6)

Start / End Page

21108

Location

Switzerland

Related Subject Headings

  • Pre-Exposure Prophylaxis
  • Poverty
  • Male
  • Humans
  • Health Policy
  • HIV Infections
  • Government Programs
  • Female
  • Cost-Benefit Analysis
  • Biomedical Research
 

Citation

APA
Chicago
ICMJE
MLA
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Cáceres, C. F., Borquez, A., Klausner, J. D., Baggaley, R., & Beyrer, C. (2016). Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy. J Int AIDS Soc, 19(7(Suppl 6)), 21108. https://doi.org/10.7448/IAS.19.7.21108
Cáceres, Carlos F., Annick Borquez, Jeffrey D. Klausner, Rachel Baggaley, and Chris Beyrer. “Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy.J Int AIDS Soc 19, no. 7(Suppl 6) (2016): 21108. https://doi.org/10.7448/IAS.19.7.21108.
Cáceres CF, Borquez A, Klausner JD, Baggaley R, Beyrer C. Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy. J Int AIDS Soc. 2016;19(7(Suppl 6)):21108.
Cáceres, Carlos F., et al. “Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy.J Int AIDS Soc, vol. 19, no. 7(Suppl 6), 2016, p. 21108. Pubmed, doi:10.7448/IAS.19.7.21108.
Cáceres CF, Borquez A, Klausner JD, Baggaley R, Beyrer C. Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy. J Int AIDS Soc. 2016;19(7(Suppl 6)):21108.

Published In

J Int AIDS Soc

DOI

EISSN

1758-2652

Publication Date

2016

Volume

19

Issue

7(Suppl 6)

Start / End Page

21108

Location

Switzerland

Related Subject Headings

  • Pre-Exposure Prophylaxis
  • Poverty
  • Male
  • Humans
  • Health Policy
  • HIV Infections
  • Government Programs
  • Female
  • Cost-Benefit Analysis
  • Biomedical Research