PrEP need met
Export Indicator
Progress towards scaling up PrEP globally and meeting the estimated need for PrEP.
This indicator is key to assessing the availability and uptake of PrEP, especially among people at substantial risk of HIV infection. Through data disaggregation, this indicator also attempts to monitor the availability and use by population (based on age, gender and key population). The use of antiretroviral medicines 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 (TDF) be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches. In 2021, WHO recommended the dapivirine vaginal ring (DVR) as an additional PrEP option to be offered to cisgender women at substantial risk of HIV. In 2022, WHO recommended that long-acting injectable cabotegravir (CAB-LA) may be offered as an additional PrEP option to people at substantial risk of HIV, and, in 2025, also injectable lenacapavir (LEN).
In 2024, WHO updated the guidance on oral PrEP dosing regimens, which are determined by a combination of factors based on a person’s characteristics, circumstances and route of exposure. The guidance no longer uses the term “event-driven PrEP”, given the variation possible within oral PrEP dosing.
Implementation of PrEP should be informed by several contextual factors, including national and subnational epidemiological trends; programmatic feasibility and demand; and consideration of the social environment for people living with HIV and people from key populations and their access to services. PrEP implementation criteria may vary by country.
Number of people who received any PrEP product at least once during the reporting period
Note: the denominator in the Spectrum model is expressed as person-years of PrEP. Therefore, the numerator needs to be adjusted downwards for an assumed average duration of use. For example, for oral PrEP, an average duration of six months could be assumed. Therefore, 1000 people who used oral PrEP at least once would translate into an average of 500 users at any given time (or 500 person years). For a six-monthly injectable with 80% continuation rate for a second dose, the adjustment can be made as follows: 1000 people who ever used the injectable translates into 500 person-years for the first six months and 400 person-years for the second six months (80% × 1000 × 0.5)—that is, 900 people who were protected at any given time (or 900 person-years). For GAM reporting, the number of people who received PrEP should be reported. A calculator to convert the number of people to person-years of PrEP is available in the online reporting tool.
Estimated number of people in need of PrEP per 1000 people per year
Numerator/denominator
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 UNAIDS/WHO standards. This can include oral PrEP, DVR, CAB-LA or LEN. The numerator should count each person only once—that is, the first time they received any PrEP product during the reporting period. People who received PrEP through national programmes or pilots, implementation studies, research or private means should be included.
For disaggregation by PrEP product (oral PrEP, DVR, CAB-LA or LEN), an individual can be counted for each product (if they received multiple products). 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 key populations that are relevant should be recorded. The sum of the data disaggregated by key population 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 people who use PrEP in the client records and registers of facilities that offer PrEP.
The denominator is the estimated number of people in need of PrEP per 1000 people per year (person-years of PrEP need). PrEP needs estimates will be available through the Spectrum software package as of 2026. If the country has conducted estimations of PrEP needs using another tool or methodology, please report these estimates and the source.
Numerator 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.
PrEP need is recommended to be estimated annually.
- Sex (male, female)
- Age (15–24 years, 25+ years)
- PrEP product (oral PrEP, DVR, CAB-LA, LEN)
- Population (gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people, pregnant and breastfeeding women)
This indicator will 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 factors such 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 estimate more accurately the number of people receiving PrEP for the first time during the calendar year than countries with aggregate data systems. In countries with weaker monitoring systems, avoiding double-counting of people receiving PrEP may be difficult, including for people who transfer to another facility for medicines during the reporting period. In these cases, the number of people receiving PrEP for the first time during the calendar year may be overstated.
The conversion of the number of people who received PrEP to person-years of protection is based on an assumed duration of PrEP use from available studies. Duration of protection will vary, depending on the type of PrEP used, and when PrEP use was started during the reporting period. As additional information becomes available on duration of PrEP use for long-acting PrEP, guidance for these conversion calculations will be refined further. Countries are encouraged to analyse the ratio of PrEP need met by population, to better understand whether PrEP programmes are effectively reaching people in need of PrEP.
PrEP needs estimates are based on assumptions around HIV incidence that is model-estimated and sexual behaviour that is self-reported. PrEP needs estimates provide a rough estimate of epidemiological need and serve to ensure comparability of PrEP coverage within and across countries. They should be interpreted with caution.
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/).
Differentiated and simplified pre-exposure prophylaxis for HIV prevention: update to WHO implementation guidance. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240053694).
Guidelines on long-acting injectable cabotegravir for HIV prevention. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240054097).
Consolidated guidelines on person-centred HIV strategic information: strengthening routine data for impact. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240055315).
PrEP target-setting for key and high-priority populations: estimating the number at risk. Geneva: Joint United Nations Programme on HIV/AIDS; 2021 (https://hivpreventioncoalition.unaids.org/sites/default/files/attachments/1.PrEP-target-setting_online.pdf).