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

15 August 2019

An increasing number of countries are adopting policies endorsing PrEP for HIV prevention. Emerging evidence from clinical research that different dosing strategies can be effective provides an opportunity to offer flexibility, choice and convenience to individuals who can benefit from PrEP and is considered by WHO in updating its guidance to countries. Based on the available evidence published so far, this technical brief updates the current WHO recommendation on oral PrEP to include an option of event-driven dosing for men who have sex with men.

Featured Resources

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Initiation and Continued Use of Oral Pre-Exposure Prophylaxis among Pregnant and Postpartum Women in South Africa (PrEP-PP): A demonstration cohort study

This article from The Lancet HIV describes the results of a demonstration study in South Africa, PrEP-PP, to integrate oral PrEP provision into public clinics offering antenatal and postnatal care to pregnant and lactating people.

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Acceptability of Six-Monthly PrEP Dispensing Supported with Interim HIV Self-Testing to Simplify PrEP Delivery in Kenya: Findings from qualitative research

This article from BMC Health Services Research discusses the results of a pilot in Kenya to explore the acceptability of dispensing PrEP twice a year, with interim HIV self-testing, versus quarterly, with clinic-based HIV testing.

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Dynamic Choice HIV Prevention with Cabotegravir Long-acting Injectable in Rural Uganda and Kenya: A randomised trial extension

This article from The Lancet HIV discusses the results of the SEARCH dynamic choice study conducted in Kenya and Uganda, comparing outcomes between one group offered a choice between oral PrEP, post-exposure prophylaxis, and cabotegravir for PrEP, and a second group receiving the standard of care.

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Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A longitudinal qualitative study from a crossover trial in South Africa, Uganda, and Zimbabwe

This article from AIDS and Behavior explores South African, Ugandan, and Zimbabwean adolescent girls and young women’s experiences in a crossover trial of two HIV prevention products: daily oral PrEP and a monthly dapivirine vaginal ring.

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Role of HIV Self-testing in Strengthening HIV Prevention Services

This article from The Lancet HIV examines the potential role of HIV self-testing (HIVST) in achieving HIV prevention goals by looking at trials of use of HIVST with prevention tools such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and voluntary medical male circumcision (VMMC).

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We Choose: Adolescent girls and young women’s choice for an HIV prevention product in a cross-over randomized clinical trial conducted in South Africa, Uganda, and Zimbabwe

This article from PLOS One describes decision-making and product choice amongst adolescent girls and young women in South Africa, Uganda, and Zimbabwe when given a choice between oral PrEP and the dapivirine vaginal ring as part of the REACH crossover study.

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“I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya

This article from PLOS One describes the results of a study using adolescent girls and young women as “mystery shoppers” in Kenya to identify barriers to effective PrEP service provision.

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Formalized Peer Referral to HIV Pre-exposure Prophylaxis Supported with Self-testing: A mixed-methods pilot study among young Kenyan women

This article from Frontiers in Public Health describes a pilot study in Kenya using peer providers and HIV self-test kits to link adolescent girls and young women to PrEP services.

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HIV Self-Testing and PrEP: Opportunities for scale-up

This brief addresses common misconceptions about the use of HIV self-testing (HIVST) for PrEP initiation and continuation while highlighting the opportunities that HIVST can provide in order to support further scale-up of this important self-care option.

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PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice

This review from Current HIV/AIDS Reports draws parallels between HIV prevention and family planning by summarizing how method choice and product switching affected contraceptive coverage globally, synthesizes what is known about PrEP product switching, and outlines evidence gaps to help guide future research on PrEP switching in the context of choice.