Graybill Lauren A, McKay Caroline N, Wang Jiayu, Sam-Agudu Nadia A, Yotebieng Marcel, Saidi Friday, Bekker Linda-Gail, Shook-Sa Bonnie E, Chi Benjamin H, Rosenberg Nora E
Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Int AIDS Soc. 2025 Jan;28(1):e26407. doi: 10.1002/jia2.26407.
While African countries have expanded access to HIV pre-exposure prophylaxis (PrEP) since 2015, regional targets for PrEP uptake remain unmet. Understanding which populations are prioritized for PrEP at the policy level is an important step in determining the scope of PrEP distribution across Africa and identifying gaps in programme implementation. We reviewed national guidance to characterize populations prioritized for PrEP in Africa.
Between January and June 2023, we searched for current National HIV Treatment and Prevention Guidelines, National HIV Strategic Plans, and the United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans (COPs) for all African countries implementing PrEP programmes supported by PEPFAR in 2022. From each document, we summarize the populations prioritized for PrEP within a country and describe PrEP eligibility.
In 2022, 19 African countries implemented PrEP programmes supported by PEPFAR. Eighteen of these countries contributed National Guidelines (2016-2022), 18 contributed National Strategic Plans (2017-2023) and 19 contributed COPs (2022) to this review. Twenty-nine population groups were prioritized for PrEP in these documents. All countries prioritized HIV-serodifferent couples, female sex workers (FSWs), adolescent girls and young women (AGYW), pregnant and breastfeeding women (PBFW) and people who inject drugs (PWID), and most prioritized men who have sex with men (MSM; n = 18), transgender people (n = 18) and people in prisons (n = 17). The remaining 21 populations were prioritized in fewer than two-thirds of countries.
FSWs, MSM, PWID, transgender people and people in prisons were typically prioritized for PrEP with no eligibility restrictions. In contrast, most countries had at least one document indicating that HIV-serodifferent couples, AGYW and PBFW were only eligible for PrEP if classified as high risk. Few documents specified how risk was determined, and no document included validated HIV risk assessment tools to guide implementation. We observed similarities in priority populations across countries with different HIV epidemics and inconsistencies in who was prioritized for PrEP within a country's own set of policy documents.
Understanding how PrEP prioritization policies impact HIV incidence in different epidemiologic settings is critical for strengthening PrEP implementation across the continent.
自2015年以来，非洲国家扩大了艾滋病毒暴露前预防（PrEP）的可及性，但PrEP的采用情况仍未达到区域目标。了解在政策层面哪些人群被列为PrEP的优先对象，是确定PrEP在非洲的分发范围以及找出项目实施差距的重要一步。我们审查了国家指南，以描述非洲被列为PrEP优先对象的人群特征。
在2023年1月至6月期间，我们搜索了所有由美国总统艾滋病紧急救援计划（PEPFAR）支持实施PrEP项目的非洲国家在2022年的现行国家艾滋病毒治疗和预防指南、国家艾滋病毒战略计划以及PEPFAR国家业务计划（COP）。从每份文件中，我们总结了一个国家内被列为PrEP优先对象的人群，并描述了PrEP的资格条件。
2022年，19个非洲国家实施了由PEPFAR支持的PrEP项目。其中18个国家提供了国家指南（2016 - 2022年），18个国家提供了国家战略计划（2017 - 2023年），19个国家提供了COP（2022年）用于本次审查。这些文件中共有29个人群组被列为PrEP的优先对象。所有国家都将艾滋病毒血清学不同的夫妇、女性性工作者（FSW）、少女和青年女性（AGYW）、孕妇和哺乳期妇女（PBFW）以及注射毒品者（PWID）列为优先对象，大多数国家还将男男性行为者（MSM；n = 18）、跨性别者（n = 18）和监狱中的人（n = 17）列为优先对象。其余21个人群在不到三分之二的国家中被列为优先对象。
FSW、MSM、PWID、跨性别者和监狱中的人通常被列为PrEP的优先对象且没有资格限制。相比之下，大多数国家至少有一份文件表明，艾滋病毒血清学不同的夫妇、AGYW和PBFW只有在被归类为高风险时才有资格使用PrEP。很少有文件说明如何确定风险，也没有文件包含经过验证的艾滋病毒风险评估工具来指导实施。我们观察到，在不同艾滋病毒流行情况的国家中，优先人群存在相似之处，而在一个国家自己的一系列政策文件中，被列为PrEP优先对象的人群存在不一致之处。
了解PrEP优先政策如何影响不同流行病学环境中的艾滋病毒发病率，对于加强整个非洲大陆的PrEP实施至关重要。
