People who received pre-exposure prophylaxis

Export Indicator

Number of people who received pre-exposure prophylaxis (PrEP) at least once during the reporting period
What it measures

Progress towards scaling up PrEP globally.

Rationale

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 (based on 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. In 2015,  the World Health Organization (WHO) recommended 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. Based on available clinical evidence, WHO updated the oral PrEP guidance in 2019 to include an option of event-driven dosing (sometimes known as "ED-PrEP") for cisgender gay men and other 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. In 2021, WHO recommended the dapivirine vaginal ring (DPV-VR) as an additional PrEP option to be offered to cisgender women at substantial risk of HIV infection. 

Implementation of PrEP should be informed by several factors. These include local service-related information - such as the epidemiological context or trends, feasibility and demand - individual assessment, and consideration of the local societal environment for people living with HIV and key populations and their access to services. The PrEP implementation criteria may vary by country.

Numerator

Number of people who received any PrEP product at least once during the reporting period

Denominator

Not applicable

Calculation

Not applicable

Method of measurement

The numerator is generated by counting the number of people who received PrEP at least once during the reporting period (the previous calendar year), in accordance with national guidelines or WHO/UNAIDS standards. This can include oral PrEP or the DPV-VR. The numerator should only count individuals once: the first time they received any PrEP product during the reporting period. People who received oral PrEP through national programmes, demonstration projects, research, or private means should be included.

For the disaggregation by PrEP product (oral PrEP or DPV-VR) and oral PrEP dosing schedule (daily or event-driven), individuals can be counted for each product (if they received multiple products) and dosing schedule (if they took oral PrEP as daily and event-driven PrEP). The sum of the data disaggregated by PrEP product and dosing schedule can therefore be greater than the total.

Age is defined as the person's age when they 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 patient records and registers of facilities that offer PrEP. This is particularly true for event-driven PrEP dosing, which is currently recommended only for gay men and other men who have sex with men and thus poses a risk of individual identification.

Measurement frequency

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.

Disaggregation
  • 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).
  • PrEP product (oral PrEP, DPV-VR).
  • Key population (gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people and prisoners).
  • For gay men and other men who have sex with men: dosing schedule (daily oral PrEP, event-driven oral PrEP).
  • Cities and other administrative areas of epidemiologic importance.
Additional information requested

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.

Strengths and weaknesses

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 that use unique identifiers will likely be able to 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 of people 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.

Further information

Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/9789240031593).

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...).

Related Indicators

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)