PrEP Tracker Data / Progress in PrEP Uptake

 Check out the PDF version of this issue and scroll for important updates.

PrEP Milestones

• The world reached nearly 5 million global cumulative PrEP initiations (4,929,913 as of June 2023), nearly double the total from one year ago.
• Overall, quarterly increases are showing modest upward trends, much of which is attributable to PEPFAR’s steady countries already receiving PEPFAR support, and the launch of PrEP programs in new countries.

• There’s been a significant uptick in the number of new countries who have begun delivering PrEP, bringing the total number of countries reporting PrEP initiations to 128. As of Q2 2023, 12 additional countries have begun to offer PrEP: Armenia, Bangladesh, Belize, Djibouti, Dominica, Gambia, Lebanon, Lithuania, Madagascar, Maldives, Mongolia, and Uzbekistan.
• Countries in Latin America are slowly starting to scale up PrEP: Argentina, Chile, and Colombia have surpassed 1,000 initiations, while Guatemala has topped 15,000 initiations.
• A few countries in Europe have also hit milestones: Czechia surpassed 1,000 initiations, Spain 10,000 initiations, and France 50,000 initiations.
• As in prior quarters, countries in Africa have seen the most PrEP scale-up. Cameroon and Ghana have surpassed 10,000 initiations, Malawi 50,000 initiations, Lesotho 100,000 initiations, and Mozambique and Tanzania 200,000 initiations.

PrEParing for New Products

• The EU commission and the government of Zambia have approved CAB for PrEP. The Association of Southeast Asian Nations’ (ASEAN) recent favorable recommendation has led the Phillipines and Malaysia to also approve CAB for PrEP. Further approvals are expected in Myanmar, Thailand and Vietnam.
• ViiV submitted for CAB approval in Cote d’Ivoire, Rwanda, Tanzania, and Mozambique.

• An increase in IS studies including Pregnant and Lactating Populations (PLP): eight of 29 CAB for PrEP studies now explicitly include PLP. For more information on PLP in HIV prevention research, see AVAC’s Including Pregnant and Lactating Populations in HIV Prevention Research factsheet.
• Only one CAB IS study is planned for people who use/inject drugs (PWU/ID). A lack of data on how best to reach this population with CAB for PrEP will make rollout more challenging. For more information, see The Choice Agenda’s recent webinar How do People Who Use/Inject Drugs Intersect with PrEP Research and Service Delivery?.
• Many IS studies are testing models of Differentiated Service Delivery (DSD). To maximize access to CAB for PrEP, many IS studies are testing delivery using non- traditional delivery channels, such as pharmacies and community-based delivery. More information is on the Full Study Details tab on the dashboard.
• Visit our Country Planning for Product Introduction tool, which tracks the regulatory status of CAB for PrEP and the dapivirine vaginal ring alongside late stage clinical trials, implementation research, and oral PrEP provision. This tool also includes PEPFAR’s plans for CAB procurement, showing plans for CAB in Malawi, Ukraine, Vietnam, Zambia and Zimbabwe as early as 2023.

PrEP Tracker Data / Progress in PrEP Uptake

In its 17th annual report released in July, the Resource Tracking for HIV Prevention R&D Working Group, a collaboration among AVAC, IAVI and UNAIDS, documents 22 years of investment in biomedical HIV prevention R&D, including HIV vaccines, PrEP, microbicides, voluntary medical male circumcision (VMMC), treatment as prevention (TasP) or undetectable equals untransmittable (U=U), female condoms and prevention of vertical transmission (PVT).

The full report is here, and key highlights below:

Global HIV Prevention R&D Investment by Technology Category, 2000-2021 (US$ millions)

• The total investment in HIV prevention R&D was US $1.25 billion in 2021, a 12% increase since 2020. A shift of funding from microbicides and prevention of vertical transmission (PVT) toward PrEP, treatment as prevention (TasP) and voluntary medical male circumcision (VMMC) was observed.
• Investment from the US public sector increased from US $857 million to US $922 million in 2021, which made up 73% of all global funding for HIV prevention R&D in 2021.
• Funding for preventive HIV vaccines decreased but continued to make up the bulk of overall HIV prevention funding at 64%. At the same time, PrEP overtook microbicides by a large margin in 2021 for the first time. Yet, when PrEP and microbicide research investments are combined (as several donors now do), there was a 52% increase in this broad ARV-based prevention category. The shift toward TasP may reflect the acceleration of U=U strategies, as well as emerging new PrEP options.
• The total investment in HIV cure R&D was US $439 million in 2021, a 30% increase since 2020. Sustained geographic diversity was observed, with several countries joining the US to increase their funding, including Canada, Switzerland and the Netherlands.

Prevention Playlist

• AVAC 2024 Advocacy Fellows Applications Now Open! Learn all about it here.
• AVAC’s Advocates’ Network brings you timely updates about developments in the biomedical HIV prevention field. Sign up today.
• The biennial International Conference on AIDS and Sexually Transmitted Infections in Africa, ICASA, will take place December 4-9 in Zimbabwe. Register here.

• From Brisbane to Chicago: A look at STIs, HIV and Global Health—a look back at two global conferences, IAS2023 and the 2023 STI and HIV world Congress (also known as ISSTDR).
• A UNAIDS high-level meeting in May brought together advocates and experts through the Global HIV Prevention Coalition to discuss how to bolster the HIV response and advance global health equity. Read AVAC’s summary.
• Our Take: Is the UN Declaration on PPPR and the Pandemic Accord going in the right direction? AVAC’s blog explores the current drafts of the Pandemic Accord and the UN Declaration on PPPR—and their implications for equity in global health.
• AVAC’s Product Introduction Country Planning Matrix tracks the regulatory status of cabotegravir for PrEP and the dapivirine vaginal ring, along with related implementation research, procurement plans, and oral PrEP provision.
• PrEP In Black America, PrEP4All, Treatment Action Group and AVAC co-hosted a webinar that explored the latest research on mpox and the ongoing fight to address disparities in infection rates that impact Black communities. Listen here.
• The Market Preparation and Introduction Strategy for the Dual Prevention Pill (DPP), has been updated and offers a roadmap on next steps to bring the DPP to market.
• The research journal Frontiers in Reproductive Health published a special issue on multipurpose prevention technologies (MPTs), including the article co-authored by AVAC’s Kate Segal and partners in our DPP Consortium, Equipping providers to offer novel MPTs: Developing counseling messages for the Dual Prevention Pill in clinical studies and beyond.
• AVAC Condemns Uganda’s Anti-Homosexuality Bill: AVAC’s statement denounces the law and calls for solidarity with Uganda’s LGBTQIA+ and civil rights advocates.

• ClusterF*#k: Molecular HIV Surveillance, Criminalization, and The Real Risks to PLHIV—this webinar explored the intersection of surveillance, bodily autonomy and criminalization.
• What’s All the Buzz About: mRNA, manufacturing, vaccine access—this webinar explored how local manufacturing and the new mRNA Hub in South Africa could facilitate access and support R&D.
• To bNAb or Not to bNAb? The case for broadly neutralizing antibodies—AVAC and partners explored the potential role of bNAbs in prevention, the status of research and development, and implications for HIV vaccine research in this webinar.
• The 11th annual South Africa AIDS Conference took place June 20-23 in Durban, South Africa. AVAC and CASPR partners hosted a buzzing Research Literacy Networking Zone. See the full schedule here, and recordings here.
• PrEP That Booty: The latest on rectal microbicide research for the back door—this webinar looked at the pipeline for shorter-acting, user-controlled products providing rectal protection.
• PEPFAR at 20: Keeping the promise—AVAC’s latest podcast episode unpacks the impact of PEPFAR and the politics of reauthorization.