Schmidt Heather-Marie A, Prochazka Mateo, Ingold Heather, Reza-Paul Sushena, Chidarikire Thato, Romyco Irvin, Rodolph Michelle
Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland.
UNAIDS, Geneva, Switzerland.
J Int AIDS Soc. 2025 Jul;28 Suppl 2(Suppl 2):e26498. doi: 10.1002/jia2.26498.
The potential of pre-exposure prophylaxis (PrEP), as a highly effective and empowering HIV prevention intervention, has not yet been realized. Despite the recent acceleration in the scale-up of oral PrEP, there is a substantial unmet PrEP need, and the world is not on track to meet the 2025 prevention targets. New PrEP products, and service delivery approaches, could support greater access, uptake, persistence and effective use. This commentary discusses how offering choice in PrEP products and service delivery innovations could transform global HIV prevention efforts.
Although oral PrEP accounts for almost all PrEP use to date, slow rollout and challenges in effective use and persistence have limited the global impact. Innovative products like long-acting injectable cabotegravir and injectable lenacapavir can overcome some of the challenges associated with oral PrEP. Expanding PrEP choices is also essential for addressing diverse individual preferences and maximizing prevention outcomes. Real-world evidence suggests that offering increased options can drive demand and increase coverage of prevention. Equally critical is tailoring service delivery through differentiated service delivery (DSD) models that prioritize accessibility and user needs and preferences, including integration of PrEP within other valued services. DSD models, including peer-led, pharmacy-based and telehealth approaches, have demonstrated success and acceptability for oral PrEP, but innovation is needed to adapt to long-acting injectable options. For example, regulatory and policy support are essential to support task-sharing with community health worker involvement may enable broader reach. Programmatic challenges, including PrEP product and service delivery costs, updating monitoring and evaluation and ensuring stakeholder support, must also be addressed. Scaling up new PrEP products using a precision prevention lens could help to optimize approaches for achieving impact.
The new era of PrEP choice, with new long-acting PrEP products and DSD options, presents countries with an extraordinary opportunity to amplify prevention access, achieve higher prevention coverage and drive the meaningful reductions in new HIV acquisitions needed to end the HIV epidemic. Without coordinated and concerted efforts within countries and supported at the global level to leverage choice and embed it within the HIV prevention response, we risk prolonging the HIV epidemic.
暴露前预防（PrEP）作为一种高效且具有赋权作用的HIV预防干预措施，其潜力尚未得到充分发挥。尽管近期口服PrEP的推广速度有所加快，但仍存在大量未满足的PrEP需求，且全球尚未走上实现2025年预防目标的正轨。新型PrEP产品及服务提供方式，能够支持更大范围的可及性、接受度、持续性及有效使用。本评论探讨了在PrEP产品及服务提供创新方面提供选择如何能够改变全球HIV预防工作。
尽管迄今为止口服PrEP几乎占据了所有PrEP的使用情况，但推广缓慢以及有效使用和持续性方面的挑战限制了其全球影响力。长效注射用卡博特韦和注射用伦那卡韦等创新产品能够克服一些与口服PrEP相关的挑战。扩大PrEP选择对于满足不同个体偏好以及使预防效果最大化也至关重要。实际证据表明，提供更多选择能够推动需求并提高预防覆盖率。同样关键的是通过差异化服务提供（DSD）模式来定制服务，这些模式优先考虑可及性以及用户需求和偏好，包括将PrEP整合到其他有价值的服务中。DSD模式，包括同伴主导、基于药房和远程医疗的方法，已证明在口服PrEP方面取得了成功且具有可接受性，但需要创新以适应长效注射选择。例如，监管和政策支持对于支持任务分担至关重要，社区卫生工作者的参与可能实现更广泛的覆盖范围。还必须解决包括PrEP产品和服务提供成本、更新监测和评估以及确保利益相关者支持在内的项目挑战。使用精准预防视角扩大新型PrEP产品的推广有助于优化实现影响力的方法。
PrEP选择的新时代，伴随着新型长效PrEP产品和DSD选项，为各国提供了一个绝佳机会，以扩大预防可及性、实现更高的预防覆盖率，并推动大幅减少新的HIV感染，从而终结HIV流行。如果各国没有在国内进行协调一致的努力，并在全球层面得到支持以利用选择并将其融入HIV预防应对措施中，我们就有可能延长HIV流行。
