Strengthening and Harmonising PrEP Indicators
Experience gained from the implementation and analysis of PrEP programs reveals significant limitations in current indicators for global PrEP monitoring. Metrics focused on numbers of ‘people receiving PrEP’ struggle to track individual clients, overlook method switching and discontinuous patterns of PrEP use, and present challenges in using indicator data to estimate PrEP coverage and program impact. The introduction of new HIV prevention options, including the PrEP ring and CAB for PrEP, offers an opportunity to re-evaluate systems for measuring the performance of PrEP programs.
The PrEP M&E Working Group under the PEPFAR/USAID funded Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) project brought together stakeholders from Eswatini, Kenya, Lesotho, Nigeria, South Africa, Uganda, Zambia, and Zimbabwe alongside global technical partners. The Working Group developed, tested, and recommended a suite of PrEP indicators that address current gaps in global PrEP M&E. The three indicators proposed as part of this suite are:
- PrEP Dispensed – the number of units of each method of PrEP product dispensed.
- PrEP Visits – the number of client visits to a health facility or access point during which PrEP was provided, prescribed, and/or administered, disaggregated by PrEP method, visit type, and population.
- Person-Years of PrEP Product Dispensed (PYP) – a composite indicator calculated from the previous two indicators, representing the total person-time of PrEP product-use dispensed, disaggregated by PrEP method and population.
These indicators offer many advantages outlined in the Indicator Proposal (see download link), including ease of collection, ease of aggregation across time periods, and the ability to inform estimates of PrEP coverage in the context of discontinuous patterns of use. In 2022, WHO added a new core indicator, “Volume of PrEP Prescribed,” to the “Consolidated Guidelines on Person Centered HIV Strategic Information: Strengthening routine data for impact.” This new indicator was informed by recommendations from the MOSAIC PrEP M&E Working Group.