Mukherjee Trena I, Yep Mitchell, Koluch Megan, Abayneh Sisay Alemayehu, Eyassu Gizachew, Manfredini Elizabeth, Herbst Sara
Office of HIV/AIDS, Prevention, Care and Treatment Division, USAID, Washington, DC, United States.
Bureau of Global Health Security and Diplomacy, President's Emergency Plan for AIDS Relief (PEPFAR), Office of Program Impact, Monitoring, and Epidemiology (PRIME), U.S. Department of State, Washington, DC, United States.
Front Reprod Health. 2024 Dec 13;6:1488970. doi: 10.3389/frph.2024.1488970. eCollection 2024.
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 PEPFAR-supported 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.
2023年，估计有130万人新感染艾滋病毒。同年，350万人接受了暴露前预防（PrEP），未达到联合国艾滋病规划署设定的到2025年覆盖2120万人的目标。由于全球超过90%的PrEP项目由美国总统防治艾滋病紧急救援计划（PEPFAR）资助，因此需要更好地了解PrEP服务提供方面的差异，以便为PEPFAR提供预防服务和在2025年在所有人群中实现联合国艾滋病规划署95-95-95目标的方法提供参考。本文的目的是评估PEPFAR资助国家中未满足的PrEP需求。
我们分析了2023财年48个PEPFAR资助国家的监测、评价和报告（MER）结果，以按地理区域和人群计算PrEP需求比（PnR）。PnR提供了一种生态学方法，用于识别PrEP项目中的差异和错失的机会。PnR计算为PrEP使用者与艾滋病毒检测呈阳性人数的比率。PrEP使用者通过新开始使用（PrEP_NEW）以及重新开始或继续使用（PrEP_CT）来定义。HTS_TST_POS衡量艾滋病毒检测呈阳性的人数，并用作新诊断病例的替代指标。在有可用数据的情况下，还使用Naomi估计的2023年艾滋病毒发病率来计算PnR。较高的PnR表明相对于人群中的PrEP需求，PrEP使用者更多。
在2023财年，1760888人开始使用PrEP，1736144人艾滋病毒检测呈阳性。PnR范围从0.12（印度）到6.46（巴西），19个（40%）国家的PrEP使用者少于艾滋病毒检测呈阳性的人数（PnR<1.0）。按人群划分，15至24岁的人群、注射毒品者和跨性别群体的PnR中位数最高。在检查估计的艾滋病毒发病率时，莫桑比克和南非报告的PnR低于平均水平，艾滋病毒发病率高于平均水平。
在PEPFAR项目中，PrEP的使用相对于人群需求在不同国家和亚人群中差异很大，这表明需要加大宣传力度、提高包容性、改善可及性并实施综合预防项目。PnR可能是人群PrEP覆盖情况和未满足需求的有用指标，并可为有效、数据驱动且以患者为中心的PEPFAR预防项目和政策提供参考。根据年龄、性别、关键人群和地理区域调整PrEP扩大规模战略对于实现联合国艾滋病规划署的目标以及到2030年将艾滋病作为对所有人的公共卫生威胁终结至关重要。
