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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-320877

ABSTRACT

Background: With the 2020 global target of three million oral pre-exposure prophylaxis (PrEP) users set during the UN General Assembly in 2016 at an end, we assessed global trends in the adoption of World Health Organization (WHO) PrEP recommendations into national guidelines and numbers of PrEP users, and estimated future trajectories of PrEP users. Methods: Data obtained through the Global AIDS Monitoring (GAM) and WHO regional offices was collated to report numbers of PrEP users and WHO PrEP recommendations adoption by country for 2016-2019. To forecast PrEP user numbers until 2023, model countries were selected in each region. PrEP use growth rates observed in these model countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. Findings: In 2019, there were 630,000 PrEP users across 76 countries (41% in Americas and 36% in African region), a 70% increase from 2018. 121 countries had adopted the WHO PrEP recommendations in national guidelines: 33 countries in 2018 and 23 in 2019. Without COVID-19 disruptions, 1·0-1·1 million global PrEP users by the end of 2020 and 2·4-5·2 million by 2023 were projected. If COVID-19 disruptions result in no PrEP user growth in 2020, there would be 0·7-1·6 million fewer PrEP users in 2023 (vs. no disruptions). Interpretation: Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. While the 2020 global PrEP target will be missed, we estimated future growth in PrEP use. In many countries, PrEP user numbers are small relative to new HIV infections and PrEP recommendations are not implemented at scale. New PrEP products could expand the PrEP user base and, with greater oral PrEP use through simplified delivery, PrEP could significantly contribute to ending AIDS by 2030. Funding Statement: We thank Unitaid for providing the funding necessary to this work.Declaration of Interests: The authors declare no conflict of interests.

2.
Lancet HIV ; 8(8): e502-e510, 2021 08.
Article in English | MEDLINE | ID: covidwho-1307281

ABSTRACT

BACKGROUND: In 2016, the UN General Assembly set a global target of 3 million oral pre-exposure prophylaxis (PrEP) users by 2020. With this target at an end, we aimed to assess global trends in the adoption of WHO PrEP recommendations into national guidelines and numbers of PrEP users, defined as people who received oral PrEP at least once in a given year, and to estimate future trajectories of PrEP use. METHODS: In this global summary and forecasting study, data on adoption of WHO PrEP recommendations and numbers of PrEP users were obtained through the Global AIDS Monitoring system and WHO regional offices. Trends in these indicators for 2016-19 by region and for 2019 by country were described, including by gender and priority populations where data were available. PrEP user numbers were forecasted until 2023 by selecting countries with at least 3 years of PrEP user data as example countries in each region to represent possible future PrEP user trajectories. PrEP user growth rates observed in example countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. FINDINGS: By the end of 2019, 120 (67%) of 180 countries with data had adopted the WHO PrEP recommendations into national guidelines (23 in 2019 and 30 in 2018). In 2019, there were about 626 000 PrEP users across 77 countries, including 260 000 (41·6%) in the region of the Americas and 213 000 (34·0%) in the African region; this is a 69% increase from about 370 000 PrEP users across 66 countries in 2018. Without COVID-19 disruptions, 0·9-1·1 million global PrEP users were projected by the end of 2020 and 2·4-5·3 million are projected by the end of 2023. If COVID-19 disruptions resulted in no PrEP user growth in 2020, the projected number of PrEP users in 2023 is 2·1-3·0 million. INTERPRETATION: Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. Although the 2020 global PrEP target will be missed, strong future growth in PrEP use is possible. New PrEP products could expand the PrEP user base, and, with greater expansion of oral PrEP, further adoption of WHO PrEP recommendations, and simplified delivery, PrEP could contribute to ending AIDS by 2030. FUNDING: Unitaid, Bill & Melinda Gates Foundation, and WHO.


Subject(s)
COVID-19/epidemiology , Global Health/trends , HIV Infections/prevention & control , Practice Guidelines as Topic , Pre-Exposure Prophylaxis , SARS-CoV-2 , Female , Humans , Male , World Health Organization
3.
J Acquir Immune Defic Syndr ; 87(3): 899-911, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1169727

ABSTRACT

BACKGROUND: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. SETTING: Yaoundé (Cameroon) and Cotonou (Benin). METHODS: We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19. RESULTS: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. CONCLUSIONS: Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , HIV-1 , SARS-CoV-2 , Benin/epidemiology , Cameroon/epidemiology , Condoms , Female , Humans , Male , Models, Biological , Risk Factors , Safe Sex , Sex Workers , Urban Population
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