More than a decade after the first efficacy evidence for oral HIV pre-exposure prophylaxis (PrEP) was reported, PrEP uptake globally has been inadequate and global HIV prevention targets have been missed. Access to PrEP is still highly concentrated in a fairly small number of countries and, even within countries with widespread PrEP access, inequalities have emerged. More ambitious, high-priority global targets for PrEP uptake are required and could accelerate the HIV prevention response in a similar way to the success of the 90-90-90 testing and treatment targets. Health systems must be PrEP-friendly and allow PrEP to be prescribed in settings already attended by large numbers of HIV-negative individuals who are at risk. Several models have been advanced for the greater demedicalisation of PrEP. Individual-level barriers to PrEP uptake and persistence have been characterised, such as low awareness, low willingness to use PrEP, and the gap between self-perceived and actual HIV risk. Overcoming these barriers will require further efforts to understand and address them first. New PrEP modalities are emerging; as more options become available, we need to develop a greater understanding of the long-term patterns of PrEP use in different populations and to develop models of such use that can accommodate people alternating through periods of use and non-use, as well as switching between dosing regimens or modalities as they become available. Scaling up PrEP is crucial to achieving the UNAIDS prevention targets for 2030. Simply getting more people onto PrEP cannot be the only goal: the big-picture definition of success for PrEP programmes must be their impact on the HIV epidemic.

在报告了口服 HIV 暴露前预防 (PrEP) 的首个疗效证据十多年后，全球对 PrEP 的吸收不足，并且未能实现全球 HIV 预防目标。PrEP 的获得仍然高度集中在少数几个国家，即使在 PrEP 获得广泛的国家内，不平等现象也出现了。需要制定更雄心勃勃的、高度优先的全球 PrEP 目标，并且可以以与 90-90-90 检测和治疗目标的成功类似的方式加速 HIV 预防反应。卫生系统必须对 PrEP 友好，并允许在已经有大量处于危险中的 HIV 阴性个体参加的环境中开具 PrEP。已经改进了几种模型以实现 PrEP 的更大程度的非医学化。个人层面对 PrEP 摄取和持久性的障碍已被表征，例如意识低、使用 PrEP 的意愿低以及自我认知和实际 HIV 风险之间的差距。克服这些障碍需要进一步努力首先了解和解决它们。新的 PrEP 模式正在出现；随着更多选择的出现，我们需要更深入地了解不同人群中 PrEP 使用的长期模式，并开发此类使用模型，以适应人们在使用和不使用期间交替以及转换给药方案或方式之间，因为它们变得可用。扩大 PrEP 对实现联合国艾滋病规划署 2030 年的预防目标至关重要。简单地让更多人接受 PrEP 并不是唯一的目标：