WHO Implementation Tool for Pre-Exposure Prophylaxis (PrEP) of HIV Infection – MODULE 1: Clinical. 7/2017

Published by WHO

Following the WHO recommendation in September 2015 that “oral pre-exposure prophylaxis (PrEP) should be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches”, partners in countries expressed the need for practical advice on how to consider the introduction of PrEP and start implementation. In response, WHO has developed this series of modules to support the implementation of PrEP among a range of populations in different settings.

Although there is growing acknowledgement of PrEP’s potential as an additional HIV prevention option and countries are beginning to consider how PrEP might be most effectively implemented, there has been limited experience with providing PrEP outside research and demonstration projects in low- and middle-income countries. Consequently, there is often uncertainty around many implementation issues. The modules in this tool provide initial suggestions for the introduction and implementation of PrEP based on currently available evidence and experience. However, it is recognized that this evidence may evolve following wider PrEP use; therefore, it is likely that this tool will require regular updating. PrEP should not replace or compete with effective and well-established HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men and harm reduction for people who inject drugs. Many people who could benefit most from PrEP belong to key population groups that may face legal and social barriers to accessing health services. This needs to be considered when developing PrEP services. Although the public health approach underpins the WHO guidance on PrEP, the decision to use PrEP should always be made by the individual concerned.

Target audience and scope of tool

This PrEP tool contains modules for a range of stakeholders to support them in the consideration, planning, introduction and implementation of oral PrEP. The modules can be used on their own or in combination. In addition, there is a module for individuals interested in or already taking PrEP. (See Summary of modules below.) This tool is the product of collaboration between many experts, community organizations and networks, implementers, researchers and partners from all regions. The information presented is aligned with WHO’s 2016 consolidated guidelines on the use of antiretroviral drugs for HIV treatment and prevention.

All modules make reference to the evidence-based 2015 WHO recommendation on PrEP. They do not make any new recommendations on PrEP, focusing instead on suggested implementation approaches.

Guiding principles

It is important to adopt a public health, human rights and people-centred approach when offering PrEP to those at substantial risk of HIV. Similar to other HIV prevention and treatment interventions, a human rights-based approach gives priority to issues concerning universal health coverage, gender equality and health-related rights including accessibility, availability, acceptability and quality of PrEP services.

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