Magni Sarah, Byamukama Daniel, Haske Maryam Sani, Mukami Jane, Moyo Idah, Auerbach Judith D
Genesis Analytics, Johannesburg, South Africa.
HIV Prevention, Uganda AIDS Commission, Kampala, Uganda.
J Int AIDS Soc. 2025 Jun;28 Suppl 1:e26447. doi: 10.1002/jia2.26447.
Post-exposure prophylaxis (PEP) is an important component of comprehensive HIV prevention, yet its uptake has been suboptimal globally. In July 2024, the World Health Organization (WHO) updated its global guidance on PEP to include two new recommendations intended to increase timely access to and delivery of PEP. These recommendations specifically aim to expand both where PEP can be delivered, to include community settings, and who can provide PEP, to include community health workers and task-sharing. The practical realities of adopting new public health guidelines to achieve the intended benefits in most contexts are complex. Articulating these realities is important for identifying what will be required to ensure the feasibility of expanded PEP access in community settings.
We provide stakeholder perspectives from five African countries-Kenya, Nigeria, South Africa, Uganda and Zimbabwe-on both barriers to and strategies for implementing the new WHO PEP recommendations. These perspectives are informed by experiences in these countries that were shared at a recent workshop and highlight key themes related to PEP uptake and use: awareness and acceptability; administration and monitoring; policy alignment, including regulatory considerations; logistics; integration of services; stakeholder involvement and capacity building; and linking PEP and PrEP more directly. Running across these themes are the roles of socio-cultural norms and the need for increased resources to pay for implementing the recommendations, including capacity strengthening and monitoring in communities.
While significant challenges exist to expanding PEP access in community settings and through task-sharing, there are examples from our countries of successful efforts to mitigate them by leveraging existing community resources and capacities in innovative ways. Additional efforts will require engagement across multiple stakeholders to address remaining awareness gaps, logistical and regulatory obstacles, and political will. As countries work to update their guidelines and align with the new WHO recommendations, continued collaboration and innovation within and across countries will be essential to realize the full potential of PEP in comprehensive HIV prevention efforts.
暴露后预防（PEP）是全面预防艾滋病毒的重要组成部分，但其在全球范围内的采用情况并不理想。2024年7月，世界卫生组织（WHO）更新了其关于PEP的全球指南，纳入了两项新建议，旨在增加及时获得和提供PEP的机会。这些建议具体旨在扩大PEP的提供地点，包括社区环境，以及扩大能够提供PEP的人员范围，包括社区卫生工作者和任务分担。在大多数情况下，采用新的公共卫生指南以实现预期效益的实际情况很复杂。阐明这些实际情况对于确定确保在社区环境中扩大PEP可及性的可行性所需条件很重要。
我们提供了来自肯尼亚、尼日利亚、南非、乌干达和津巴布韦这五个非洲国家的利益相关者的观点，涉及实施世卫组织新的PEP建议的障碍和策略。这些观点基于这些国家在最近一次研讨会上分享的经验，并突出了与PEP采用和使用相关的关键主题：认识和可接受性；管理和监测；政策一致性，包括监管考虑；后勤；服务整合；利益相关者参与和能力建设；以及更直接地将PEP和PrEP联系起来。贯穿这些主题的是社会文化规范的作用以及需要增加资源来支付实施这些建议的费用，包括在社区进行能力加强和监测。
虽然在社区环境中通过任务分担扩大PEP可及性存在重大挑战，但我们国家有一些成功的例子，通过以创新方式利用现有的社区资源和能力来缓解这些挑战。还需要做出更多努力，让多个利益相关者参与，以解决剩余的认识差距、后勤和监管障碍以及政治意愿问题。随着各国努力更新其指南并与世卫组织的新建议保持一致，国家内部和国家之间持续的合作与创新对于在全面预防艾滋病毒工作中充分发挥PEP的潜力至关重要。
