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

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dc.contributor.author Caceres Palacios, Carlos Fernando
dc.contributor.author Borquez, Annick
dc.contributor.author Klausner, Jeffrey-D.
dc.contributor.author Baggaley, Rachel
dc.contributor.author Beyrer, Chris
dc.date.accessioned 2019-02-06T14:51:18Z
dc.date.available 2019-02-06T14:51:18Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/5197
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries Journal of the International AIDS Society
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject acceptability en_US
dc.subject combination prevention en_US
dc.subject Health Policy en_US
dc.subject health systems en_US
dc.subject HIV en_US
dc.subject implementation science en_US
dc.subject pre-exposure prophylaxis en_US
dc.subject Pre-Exposure Prophylaxis en_US
dc.subject program cost en_US
dc.subject scale-up en_US
dc.subject Anti-HIV Agents/therapeutic use en_US
dc.subject Biomedical Research en_US
dc.subject Cost-Benefit Analysis en_US
dc.subject Female en_US
dc.subject Government Programs en_US
dc.subject HIV Infections/drug therapy/prevention & control en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Poverty en_US
dc.title Implementation of pre-exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7448/IAS.19.7.21108
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1758-2652


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