HIV pre-exposure prophylaxis implementation in Africa: some early lessons

Abstract

Since antiretrovirals were first shown to prevent sexual transmission of HIV,1 numerous randomised trials have reported that oral pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV infection in a range of settings and populations.2 However, there can be a substantial gap between efficacy in controlled clinical trial settings and effectiveness in real-world implementation, generally referred to as the efficacy-effectiveness gap. For example, three large HIV test-and-treatment implementation trials failed to demonstrate effectiveness in community settings, even though the initial individual treatment trial reported very high efficacy.