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ORIGINAL RESEARCH article

Front. Reprod. Health
Sec. HIV and STIs
Volume 6 - 2024 | doi: 10.3389/frph.2024.1488970
This article is part of the Research Topic Accelerating to 2030 – Doubling Down on HIV Prevention to End HIV/AIDS as a Public Health Threat View all 6 articles

Disparities in PrEP use and unmet need across PEPFAR-supported programs: doubling down on prevention to put people first and end AIDS as a public health threat by 2030

Provisionally accepted
Trena Mukherjee Trena Mukherjee 1*Mitchell Yep Mitchell Yep 1Megan Koluch Megan Koluch 2Sisay Alemayehu Abayneh Sisay Alemayehu Abayneh 3Gizachew Eyassu Gizachew Eyassu 4Elizabeth Manfredini Elizabeth Manfredini 1Sara Herbst Sara Herbst 2
  • 1 United States Agency for International Development, Washington D.C., United States
  • 2 United States Department of State, Washington, D.C, Washington, United States
  • 3 US Embassy Rwanda, Kigali, Rwanda
  • 4 US Embassy Ethiopia, Addis Ababa, Ethiopia

The final, formatted version of the article will be published soon.

    In 2023, an estimated 1.3 million people newly acquired HIV. In the same year, 3.5 million individuals received pre-exposure prophylaxis (PrEP), falling short of the UNAIDS target of 21.2 million by 2025. With over 90% of global PrEP programming supported by PEPFAR, a better understanding of disparities in PrEP provision is needed to inform PEPFAR's approach to reach and deliver prevention services and achieve UNAIDS 95-95-95 goals in all populations by 2025. The objective of this paper is to assess unmet PrEP need in PEPFAR-supported countries.We analyzed FY2023 Monitoring, Evaluation, and Reporting (MER) results from 48 PEPFARsupported countries to calculate PrEP-to-need ratios (PnR) by geography and population. PnR offers an ecological measure to identify disparities and missed opportunities for PrEP programming. PnR was calculated as the ratio of PrEP users to the number of positive HIV tests. PrEP users are defined through new initiations (PrEP_NEW) and re-initiations or continuation (PrEP_CT). HTS_TST_POS measures the number of positive HIV tests and was used as a proxy for new diagnoses. PnR was also calculated using Naomi-estimated 2023 HIV incidence, where available. A higher PnR indicates more PrEP users relative to PrEP need in a population.In FY23, 1,760,888 people initiated PrEP, and 1,736,144 people tested positive for HIV. PnR ranged from 0.12 (India) to 6.46 (Brazil), and 19 (40%) countries had fewer PrEP users than positive HIV tests (PnR <1.0). By population, people 15-24 years old, people who inject drugs, and transgender populations had the highest median PnR. When examining estimated HIV incidence, Mozambique and South Africa reported lower than average PnR and higher than average HIV incidence.PrEP use relative to population need varied greatly by country and subpopulation across PEPFAR programs, suggesting a need for greater advocacy, inclusivity, accessibility, and integrated prevention programming. PnR may be a useful indicator of population PrEP coverage and unmet need, and can inform effective, data-driven, and person-centered PEPFAR prevention programming and policies. Tailoring PrEP scale-up strategies by age, sex, key population, and geography is crucial to achieving UNAIDS targets and ending the AIDS epidemic as a public health threat for all by 2030.

    Keywords: PrEP-to-need ratio, PEPFAR, PrEP, hiv prevention, Key populations, AGYW, HIV

    Received: 31 Aug 2024; Accepted: 19 Nov 2024.

    Copyright: © 2024 Mukherjee, Yep, Koluch, Abayneh, Eyassu, Manfredini and Herbst. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Trena Mukherjee, United States Agency for International Development, Washington D.C., United States

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