Background

In 2016, the UN General Assembly set a global target of 3 million oral pre-exposure prophylaxis (PrEP) users by 2020. With this target at an end, we aimed to assess global trends in the adoption of WHO PrEP recommendations into national guidelines and numbers of PrEP users, defined as people who received oral PrEP at least once in a given year, and to estimate future trajectories of PrEP use.

Methods

In this global summary and forecasting study, data on adoption of WHO PrEP recommendations and numbers of PrEP users were obtained through the Global AIDS Monitoring system and WHO regional offices. Trends in these indicators for 2016–19 by region and for 2019 by country were described, including by gender and priority populations where data were available. PrEP user numbers were forecasted until 2023 by selecting countries with at least 3 years of PrEP user data as example countries in each region to represent possible future PrEP user trajectories. PrEP user growth rates observed in example countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020.

Findings

By the end of 2019, 120 (67%) of 180 countries with data had adopted the WHO PrEP recommendations into national guidelines (23 in 2019 and 30 in 2018). In 2019, there were about 626 000 PrEP users across 77 countries, including 260 000 (41·6%) in the region of the Americas and 213 000 (34·0%) in the African region; this is a 69% increase from about 370 000 PrEP users across 66 countries in 2018. Without COVID-19 disruptions, 0·9–1·1 million global PrEP users were projected by the end of 2020 and 2·4–5·3 million are projected by the end of 2023. If COVID-19 disruptions resulted in no PrEP user growth in 2020, the projected number of PrEP users in 2023 is 2·1–3·0 million.

Interpretation

Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. Although the 2020 global PrEP target will be missed, strong future growth in PrEP use is possible. New PrEP products could expand the PrEP user base, and, with greater expansion of oral PrEP, further adoption of WHO PrEP recommendations, and simplified delivery, PrEP could contribute to ending AIDS by 2030.

Funding

Unitaid, Bill & Melinda Gates Foundation, and WHO.

中文翻译：

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口服暴露前预防指南的采用和使用：一项全球总结和预测研究

背景

2016 年，联合国大会设定了到 2020 年达到 300 万口服暴露前预防 (PrEP) 用户的全球目标。随着这一目标的结束，我们旨在评估将世卫组织 PrEP 建议纳入国家指南的全球趋势，以及PrEP 用户的数量，定义为在给定年份至少接受一次口服 PrEP 的人，并估计未来 PrEP 使用的轨迹。

方法

在这项全球总结和预测研究中，通过全球艾滋病监测系统和世卫组织区域办事处获得了关于采用世卫组织 PrEP 建议和 PrEP 用户数量的数据。描述了 2016-19 年按区域和 2019 年按国家/地区划分的这些指标的趋势，包括在可获得数据的情况下按性别和优先人群划分。通过选择具有至少 3 年 PrEP 用户数据的国家作为每个地区的示例国家，预测到 2023 年的 PrEP 用户数量，以代表未来可能的 PrEP 用户轨迹。在示例国家中观察到的 PrEP 用户增长率应用于不同场景下的相应地区国家，包括 COVID-19 中断场景，2020 年全球 PrEP 使用静态。

发现

到 2019 年底，拥有数据的 180 个国家中有 120 个（67%）已将 WHO PrEP 建议纳入国家指南（2019 年为 23 个，2018 年为 30 个）。2019年，全球77个国家约有62.6万名PrEP用户，其中美洲地区26万（41·6%），非洲地区21.3万（34·0%）；这比 2018 年 66 个国家/地区的约 370,000 名 PrEP 用户增加了 69%。如果没有 COVID-19 中断，预计到 2020 年底全球 PrEP 用户将达到 0·9-1·10 万，2·4-5·3预计到 2023 年底将达到 100 万。如果 COVID-19 中断导致 2020 年 PrEP 用户没有增长，那么 2023 年 PrEP 用户的预计数量为 2·1-3·0 万。

解释

世卫组织 PrEP 建议的广泛采用恰逢全球 PrEP 使用增加。尽管 2020 年全球 PrEP 目标将无法实现，但未来 PrEP 使用的强劲增长是可能的。新的 PrEP 产品可以扩大 PrEP 用户群，并且随着口服 PrEP 的进一步扩大、进一步采用 WHO PrEP 建议和简化交付，PrEP 可以为到 2030 年终结艾滋病做出贡献。

资金

Unitaid、比尔和梅琳达盖茨基金会和世卫组织。