Following WHO's 2015 recommendation, countries in sub-Saharan Africa have progressively scaled up oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention. PrEP has potential to significantly reduce new HIV infections in sub-Saharan Africa if it is widely available, accessible, and effectively used. Initial scale-up efforts have generated progress, drawing lessons from existing HIV interventions, such as antiretroviral therapy and biomedical prevention. However, beset by unprepared health systems, scale-up has been slow, resulting in suboptimal coverage among priority groups at higher risk of HIV acqusition. Using the WHO health system building blocks framework, this Review synthesises literature on essential considerations for PrEP scale-up in sub-Saharan Africa, highlighting the importance of health system adaptability and responsiveness.

根据世卫组织 2015 年的建议，撒哈拉以南非洲国家已逐步扩大口服暴露前预防 (PrEP) 作为艾滋病联合预防的一部分。如果 PrEP 广泛可用、可及且有效使用，它有可能显着减少撒哈拉以南非洲地区的新 HIV 感染。从抗逆转录病毒治疗和生物医学预防等现有艾滋病毒干预措施中汲取经验教训，初步扩大规模取得了进展。然而，由于卫生系统准备不足，扩大规模一直很缓慢，导致艾滋病毒感染风险较高的优先群体的覆盖率不理想。使用世卫组织卫生系统构建模块框架，本审查综合了有关在撒哈拉以南非洲扩大 PrEP 的基本考虑因素的文献，