Global adoption of guidelines on and use of oral pre-exposure prophylaxis (PrEP): current situation and future projections


BACKGROUND: With the 2020 global target of three million oral pre-exposure prophylaxis (PrEP) users set during the UN General Assembly in 2016 at an end, we assessed global trends in the adoption of World Health Organization (WHO) PrEP recommendations into national guidelines and numbers of PrEP users, and estimated future trajectories of PrEP users.
METHODS: Data obtained through the Global AIDS Monitoring (GAM) and WHO regional offices was collated to report numbers of PrEP users and WHO PrEP recommendations adoption by country for 2016-2019. To forecast PrEP user numbers until 2023, model countries were selected in each region. PrEP use growth rates observed in these model countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020.
RESULTS: In 2019, there were 630,000 PrEP users across 76 countries (41% in Americas region and 36% in African region), a 70% increase from 2018. 124 countries had adopted the WHO PrEP recommendations in national guidelines: 35 countries in 2018 and 24 in 2019. Without COVID-19 disruptions, 1.0-1.1 million global PrEP users by the end of 2020 and 2.4-5.2 million by 2023 were projected (see figure).

CONCLUSIONS: Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. While the 2020 global PrEP target will be missed, we estimated future growth in PrEP use. In many countries, PrEP user numbers are small relative to numbers of new HIV infections and PrEP recommendations are not implemented at scale, limiting current impact of PrEP on reducing HIV incidence. New PrEP products could expand the PrEP user base and, together with greater oral PrEP use through simplified delivery, PrEP could make a significant contribution to ending AIDS by 2030.