People who received PrEP
Progress towards scaling up PrEP globally.
This indicator is key to assessing the availability and uptake of PrEP, especially among people at higher risk of HIV infection. Through data disaggregation, this indicator will also attempt to monitor the availability and use by population (age, gender and key population).
The use of antiretroviral medicine by people who are HIV-negative before they are exposed to HIV can prevent HIV infection. PrEP has been shown to be effective in a wide range of HIV-negative populations. Based on available clinical evidence, the World Health Organization (WHO) updated the oral PrEP guidance in 2019 to include an option of event-driven dosing (ED-PrEP) for men who have sex with men. This shorter dosing strategy has the potential to reduce pill burden, potential toxicity and the cost of drugs, and it may improve continuation among those who find daily pill-taking challenging, but it is not currently recommended for other population groups.
WHO recommends that oral PrEP containing tenofovir be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches. WHO provisionally defines substantial risk of HIV infection as HIV incidence of about 3 per 100 person-years or higher in the absence of PrEP. Implementation should be informed by local information, including the epidemiological context or trends, feasibility and demand, as well as individual assessment and consideration of the local environment related to people living with HIV and key populations in order to protect their safety. The implementation criteria may vary by country.
Number of people who received oral PrEP at least once during the reporting period
The numerator is generated by counting the number of people who received oral PrEP at least once during the reporting period (the previous calendar year), in accordance with national guidelines or WHO/UNAIDS standards. The numerator should only count individuals once: the first time they received oral PrEP during the reporting period. People who received oral PrEP through national programmes, demonstration projects, research, or through private means should be included.
Age is defined as the age at the time the person received PrEP for the first time during the reporting period.
If a person identifies as belonging to more than one key population, all that are relevant should be recorded. The sum of the data disaggregated by key populations can therefore be greater than the total. As with all types of record-keeping used to disaggregate indicators by key population, efforts must be made to avoid disclosing the identities of PrEP users in the patients records and registers of facilities that offer PrEP but that also serve people who are not part of a key population. This is particularly true for ED-PrEP dosing, which is currently recommended only for men who have sex with men and thus poses a risk of individual identification.
Data should be collected continuously at the facility level and aggregated periodically, preferably monthly or quarterly. The most recent monthly or quarterly data should be used for annual reporting.
- People who received PrEP for the first time in their lives.
- Gender (male, female or transgender).
- Age (<15, 15+ 15–19, 20–24, 25–49 and 50+ years).
- Key population (men who have sex with men, sex workers, people who inject drugs, and transgender people and prisoners).
- For men who have sex with men: dosing schedule (daily oral PrEP, event-driven PrEP).
- Cities and other administrative areas of importance.
If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. Submit the digital version of any available survey reports using the upload tool.
This indicator will not capture the number of person-years at risk, since it will not account for how long PrEP is used. It will also not measure the treatment cost, quality, effectiveness or adherence, which vary within and among countries and are likely to change over time.
The availability and use of PrEP will depend on such factors as cost, service delivery infrastructure and quality, legal and policy environment, perceptions of effectiveness and possible side-effects.
Countries with strong monitoring systems and using unique identifiers will likely more accurately estimate the number of people receiving PrEP for the first time during the calendar year than those with aggregate data systems. In countries with weaker monitoring systems, avoiding double-counting of the people receiving PrEP may be difficult, including those who may transfer to another facility to receive medication during the reporting period. In these cases, the number of people receiving PrEP for the first time during the calendar year may be overstated.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?...).
WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection. Geneva: World Health Organization; 2017 (http://www.who.int/hiv/pub/prep/prep-implementation-tool/en/).
What's the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: update to WHO's recommendation on oral PrEP. Technical brief. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/bitstream/handle/10665/325955/WHO-CDS-HIV-19.8...).
Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/consolidated-hiv-strategic-infor...).
PR.5 Currently on PrEP, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines)
PrEP_CURR, PEPFAR, MER 2.0 (Version 2.4), September 2019, Monitoring, Evaluation, and Reporting (https://www.state.gov/wp-content/uploads/2019/10/PEPFAR-MER-Indicator-Reference-Guide-Version-2.4-FY20.pdf)