WHO launched today a new technical brief on implementation guidance for simplified and differentiated service delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. Since 2015, when WHO recommended offering oral PrEP to all people at substantial risk of HIV, there has been a global uptake of PrEP into national guidelines and widespread implementation of PrEP services. In many countries, services have been demedicalized, simplified, differentiated, digitalized, and integrated to increase uptake and effective use of PrEP. These trends have been particularly accelerated by the COVID-19, which required innovative approaches to maintain PrEP services.
This WHO technical brief aims to support a range of stakeholders in planning and implementing PrEP services by providing implementation guidance for differentiated and simplified service delivery. It supplements and updates guidance previously published in the WHO Consolidated HIV Guidelines and the WHO PrEP Implementation Tool. This will support efforts to achieve the goals set out in the 2022–2030 Global Health Sector Strategies on HIV, Viral Hepatitis, and Sexually Transmitted Infections, which recognizes implementation of PrEP services as a key action.
The technical brief covers a range of topics:
- Starting, using, and stopping oral PrEP: New guidance notes that event-driven oral PrEP use (ED-PrEP, also known as 2+1+1) is appropriate to prevent sexual acquisition of HIV by all cisgender men and trans and gender diverse people assigned male at birth who are not taking exogenous estradiol-based hormones. For those not eligible for ED-PrEP, the guidance notes that daily oral PrEP can be stopped by taking daily PrEP 7 days after the last potential exposure.
- Hepatitis B virus (HBV) and hepatitis C virus (HCV): The technical brief emphasises that PrEP services provide an important opportunity to screen for HBV and HCV infection and provide linkages to care. Both daily PrEP and ED-PrEP can safely be offered to people with HBV.
- Kidney function: New guidance is provided on the frequency of kidney function measurement, including that kidney function measurement can be considered optional among individuals aged 30 years and younger with no kidney-related comorbidities. As risks of kidney impairment remain low among those aged 30–49 years without kidney-related comorbidities, kidney function monitoring can be considered optional in this group, too, depending on available resources.
- HIV self-testing (HIVST) for PrEP: The technical brief notes that HIVST can complement existing HIV testing strategies for PrEP services and enable differentiated service delivery approaches for oral PrEP and the dapivirine vaginal ring to reduce clinic visits. HIVST provides an additional choice to PrEP users.
- Differentiated PrEP service delivery: A differentiated PrEP service delivery approach is person- and community-centred and adapts services to the needs and preferences of the people who are interested in and could benefit from PrEP. Differentiated PrEP services may make PrEP services more acceptable and accessible and support PrEP uptake, persistence, and effective use. The technical brief outlines a common framework for differentiated PrEP service delivery that utilizes the 4 building blocks of where (service location), who (service provider), when (service frequency), and what (service package).
WHO continues to support countries as they implement comprehensive, differentiated PrEP services for all who could benefit from PrEP. The WHO Global PrEP Network will host webinars on updates to PrEP guidance.