People who received PrEP

Export Indicator

Number of people who received oral pre-exposure prophylaxis (PrEP) at least once during the reporting period
What it measures

Progress towards scaling up PrEP and the expanded Fast-Track Target of reaching 3 million people with PrEP by 2020.

Rationale
This indicator is key to assessing the availability and uptake of PrEP, especially among people at higher risk of HIV infection. Through data disaggregation, this indicator will also attempt to monitor the availability and use by population (age, gender and key population).
 
The use of antiretroviral medicine by people who are HIV-negative before they are exposed to HIV can prevent HIV infection. Clinical trials have shown that oral PrEP can reduce the number of people acquiring HIV among serodiscordant couples, heterosexual men, women, men who have sex with men, people who inject drugs and transgender women.
 
WHO recommends that oral PrEP containing tenofovir be offered as an additional prevention choice for people at substantial risk of HIV infection as part of combination HIV prevention approaches. WHO provisionally defines substantial risk of HIV infection as HIV incidence of about 3 per 100 person-years or higher in the absence of PrEP. Implementation should be informed by local information, including the epidemiological context or trends, feasibility and demand, as well as individual assessment and consideration of the local environment related to people living with HIV and key populations in order to protect their safety. The implementation criteria may vary by country.
Numerator

Number of people who received oral PrEP at least once during the reporting period

Denominator

Not applicable

Calculation

Not applicable

Method of measurement
The numerator is generated by counting the number of people who received oral PrEP at least once during the reporting period (the previous calendar year), in accordance with national guidelines or WHO/UNAIDS standards. The numerator should only count individuals once: the first time they received oral PrEP during the reporting period. People who received oral PrEP through national programmes, demonstration projects, research, or through private means— but are taking it according to WHO/UNAIDS standards—should be included.
 
Age is defined as the age at the time the person received PrEP for the first time during the reporting period.
 
If a person identifies as belonging to more than one key population, all that are relevant should be recorded. The sum of the data disaggregated by key populations can therefore be greater than the total.
Measurement frequency
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.
Disaggregation
  • People who received PrEP for the first time in their lives.
  • Gender (male, female or transgender).
  • Age (<15, 15+ 15–19, 20–24, 25–49 and 50+ years).
  • Key population (men who have sex with men, sex workers, people who inject drugs, and transgender people and prisoners).
  • Cities and other administrative areas of importance.
Additional information requested
If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. Submit the digital version of any available survey reports using the upload tool.
Strengths and weaknesses
This indicator will not capture the number of person-years at risk, since it will not account for how long PrEP is used. It will also 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 such factors as cost, service delivery infrastructure and quality, legal and policy environment, perceptions of effectiveness and possible side-effects.
 
Countries with strong monitoring systems and using unique identifiers will likely more accurately estimate the number of people receiving PrEP for the first time during the calendar year than those with aggregate data systems. In countries with weaker monitoring systems, avoiding double-counting of the people receiving PrEP may be difficult, including those who may transfer to another facility to receive medication during the reporting period. In these cases, the number of people receiving PrEP for the first time during the calendar year may be overstated.
Further information
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Second edition. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?... 15 November 2016).
 
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/).