MMWR Morb Mortal Wkly Rep. 2020 Feb 28;69(8):212-215. doi: 10.15585/mmwr.mm6908a3.
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the largest bilateral funder of human immunodeficiency virus (HIV) prevention and control programs worldwide, currently supports implementation of preexposure prophylaxis (PrEP) to reduce HIV incidence among persons at substantial risk for infection, including female sex workers, men who have sex with men (MSM), and transgender women (hereafter referred to as key populations). Recent estimates suggest that 54% of all global new HIV infections in 2018 occurred among key populations and their sexual partners (1). In 2016, PEPFAR began tracking initiation of PrEP by key populations and other groups at high risk (2). The implementation and scale-up of PrEP programs across 35 PEPFAR-supported country or regional programs* was assessed by determining the number of programs reporting any new PrEP clients during each quarter from October 2016 to September 2018. As of September 2018, only 15 (43%) PEPFAR-supported country or regional programs had implemented PrEP programs; however, client volume increased by 3,351% over the assessment period in 15 country or regional programs. Scale-up of PrEP among general population clients (5,255%) was nearly three times that of key population clients (1,880%). Among key populations, the largest increase (3,518%) occurred among MSM. Factors that helped drive the success of these PrEP early adopter programs included initiation of national, regional, and multilateral stakeholder meetings; engagement of ministries of health and community advocates; revision of HIV treatment guidelines to include PrEP; training for HIV service providers; and establishment of drug procurement policies. These best practices can help facilitate PrEP implementation, particularly among key populations, in other country or regional programs to reduce global incidence of HIV infection.
美国总统艾滋病紧急救援计划（PEPFAR）是全球最大的双边艾滋病毒（HIV）预防和控制项目资金提供者，目前支持实施暴露前预防（PrEP），以降低具有较高感染风险的人群（包括女性性工作者、男男性行为者和跨性别女性）的 HIV 感染率。最近的估计表明，2018 年全球所有新的 HIV 感染中有 54%发生在这些关键人群及其性伴侣中（1）。2016 年，PEPFAR 开始跟踪关键人群和其他高风险人群开始使用 PrEP 的情况（2）。通过确定从 2016 年 10 月至 2018 年 9 月每个季度报告任何新的 PrEP 客户的项目数量，评估了 35 个 PEPFAR 支持的国家或区域方案*中 PrEP 方案的实施和扩大情况。截至 2018 年 9 月，只有 15 个（43%）PEPFAR 支持的国家或区域方案实施了 PrEP 方案；然而，在 15 个国家或区域方案中，客户数量在评估期间增加了 3351%。普通人群客户（5255%）对 PrEP 的推广几乎是关键人群客户（1880%）的三倍。在关键人群中，MSM 群体的增幅最大（3518%）。推动这些 PrEP 早期采用方案成功的因素包括启动国家、区域和多边利益攸关方会议；调动卫生部门和社区倡导者参与；修订艾滋病毒治疗指南以纳入 PrEP；对艾滋病毒服务提供者进行培训；以及制定药品采购政策。这些最佳实践有助于促进其他国家或地区方案中 PrEP 的实施，特别是在关键人群中，以降低全球 HIV 感染率。
