Getting pre-exposure prophylaxis (PrEP) to the people - opportunities, challenges and examples of successful health service models of PrEP implementation

Sep 28, 2026

Uploaded by Aditya

Editorial overview of pre-exposure prophylaxis (PrEP) implementation, highlighting how antiretroviral-based strategies could help end the HIV epidemic. Discusses the 2016 UN Fast-Track approach and the goal of rapid PrEP scale-up, while emphasizing practical barriers to expanding services. Presents contributions describing targets, policy translation into care, clinical guidance gaps (including pregnancy and postpartum), and approaches to improve access, demand creation, and retention across health systems.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Editorial: PrEP to the people

Global targets and Fast-Track scale-up

Service delivery, policy translation, and demand creation

Clinical guidance gaps and improving access

CSIRO PUBLISHING Sexual Health, 2018, 15, 481–484 [https://doi.org/10.1071/SH18182](https://doi.org/10.1071/SH18182) Editorial Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges and examples of successful health service models of PrEP implementation Iryna B. Zablotska A,F, Jared M. Baeten B, Nittaya Phanuphak C, Sheena McCormack D and Jason OngE A Faculty of Medicine and Health, The University of Sydney, 162 Marsden Street, Parramatta, NSW 2150, Australia. BSchools of Medicine and Public Health, University of Washington, 325 Ninth Ave, Box 359927, Seattle, WA 98104, USA. CThe Thai Red Cross AIDS Research Centre, Bangkok, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand. DMRC Clinical Trials Unit at UCL, University College London, 90 High Holborn, London WC1V 6LJ, UK. E London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. FCorresponding author. Email: [iryna.zablotska@sydney.edu.au](iryna.zablotska@sydney.edu.au) Received 25 September 2018, accepted 4 October 2018, published online 29 November 2018 The world population has immensely suffered from the HIV/ AIDS pandemic for nearly four decades. However, the advent of highly effective antiretrovirals could facilitate an end to the global epidemic. Effective HIV antiretroviral treatment has saved millions of lives of people with HIV since the mid-1990s and eliminates transmission risk from those who take it and have undetectable viral loads. Now, all evidence is in agreement that pre-exposure prophylaxis (PrEP) with antiretrovirals could prevent millions of infections as well.1 Armed with evidence, the 2016 United Nations (UN) declaration2 set the Sustainable Development Goal of ending AIDS as a public health threat by 2030 .3 To achieve this goal, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has put forward a new ‘Fast-Track’ approach to HIV prevention.4 It calls for a rapid scale-up of HIV prevention services and sets a target of three million people on PrEP by 2020.5 For those who work in HIV prevention, there is no doubt that antiretrovirals, both as treatment and PrEP, provide an opportunity to stop HIV transmission altogether. And yet, getting PrEP to the people is challenging – to date PrEP services have been established only in a few settings. This special issue of Sexual Health brings to light the opportunities and challenges for health service providers engaged in PrEP implementation. We discuss goal setting, policies, demand creation and what it takes to attract, serve and retain PrEP users. This is illustrated using experiences of PrEP implementation pioneers from around the world. Coleman opens this special issue with the discussion of PrEP implementation targets.6 The ambitious global target was set up by UNAIDS to stimulate engagement with PrEP by national HIV programs.5 Already 20 countries with the highest annual number of new HIV infections have revisited their prevention goals, or set the new ones, and developed detailed targets for PrEP rollout.7 There are, however, some challenges with national target setting: estimates of the size of key populationsand data on PrEP demand are often not readily available. Coleman recommends that countries, where population size estimates are not available, can take a gradual approach to PrEP implementation; that is, start with small PrEP projects, set-up pragmatic targets for speciﬁc sites offering PrEP and make services as accessible as possible. Such approaches will inform the likely PrEP uptake patterns and future target calculations. Targets themselves will only be meaningful if they address the needs of the priority populations, stimulate PrEP demand and encourage the health-sector resource allocation and capacity building. PrEP targets should be a part of comprehensive prevention planning and require all stakeholders’ endorsement.8 Biomedical technologies have fundamentally changed the business of HIV prevention and s

FAQs

What global strategy supports the scale-up of PrEP implementation?

The 2016 UN declaration and the UNAIDS ‘Fast-Track’ approach call for rapid expansion of HIV prevention services, targeting three million people on PrEP by 2020.

What makes getting PrEP to the people challenging?

PrEP services are still limited to a few settings, and national planning often lacks key population size estimates and PrEP demand data, making targets difficult to set and services harder to expand.

Which clinical guidance area is identified as underdeveloped?

The use of PrEP in pregnancy and postpartum remains underdeveloped, with policy and health system barriers affecting access for women in high-prevalence settings.

Sep 28, 2026

Uploaded by Aditya