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Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Guideline

Southern African guidelines on the safe, easy and

effective use of pre-exposure prophylaxis: 2020

Authors: Introduction
Linda-Gail Bekker 1
Benjamin Brown Pre-exposure prophylaxis (PrEP) with antiretroviral agents to prevent human immunodeficiency
2
Dvora Joseph-Davey virus (HIV) acquisition is now a standard of care in many countries. After more than a decade of
3,4
Kathrine Gill 1 research and dozens of randomised trials, it is clear that PrEP is both safe and efficacious. Oral
Michelle Moorhouse 5
Sinead Delany-Moretlwe 5 PrEP is thus a key component of an HIV prevention package and should be offered to anyone
Landon Myer 4 who may be exposed to HIV, whether sexually or through other means. With the highest HIV
Catherine Orrell incidence in the world, PrEP use in the South African population remains unacceptably low and
1,6
Kevin Rebe
7,8
W.D. Francois Venter 9 insufficient to reach its full impact as an HIV control measure. To realise the full value of this
Carole L. Wallis prevention tool, PrEP must become more accessible. Therefore, the updated 2020 PrEP guidelines
10
have (1) broadened eligible groups to include pregnant and breastfeeding women, (2) reduced
Affiliations:
1 Desmond Tutu HIV Centre, clinical and health system barriers to simplify PrEP initiation and administration (e.g. same-day
Institute of Infectious Disease PrEP), (3) broadened PrEP delivery to include on-demand PrEP in men who have sex with men
and Molecular Medicine, and transgender women, (4) provided updates of adverse events and relevant drug–drug
University of Cape Town, interactions and (5) suggested parameters with which to measure PrEP rollout and success.
Cape Town, South Africa
2 Anova Health Institute, Background
Johannesburg, South Africa
The first Southern African HIV Clinicians Society pre-exposure prophylaxis (PrEP) guidelines
3 Department of Epidemiology, were published in the Southern African Journal of HIV Medicine in 2012 following labelling
University of California, Los approval by the Federal Drug Administration (FDA) in the United States of America. The
1
Angeles, United States of
America results of three clinical trials underpinned those guidelines: the Global iPrEx study in men who
have sex with men (MSM) and transgender (TG) people, the Partners PrEP study in discordant
4 Division of Epidemiology and couples in Uganda and Kenya and the tenofovir disoproxil fumarate (TDF) 2 study in
Biostatistics, School of Public heterosexual men and women from Botswana. 2,3,4,5 Since then a further seven randomised
Health and Family Medicine,
University of Cape Town, controlled trials (RCTs) and numerous open label demonstration studies have led to the
Cape Town, South Africa registration of combination therapy, with tenofovir and emtricitabine or related variations
thereof as effective tools in the prevention of human immunodeficiency virus (HIV) transmission
5 Wits Reproductive Health and
HIV Research Unit, University to uninfected persons. 6,7,8,9,10,11,12,13,14,15,16,17,18,19 The World Health Organization (WHO) set a target
of the Witwatersrand, of 3 million PrEP users worldwide by 2020. With 240 000 incident HIV infections per year in
Johannesburg, South Africa South Africa, which is equivalent to almost 15% of all new infections globally, a significant
20
portion of those effective PrEP users should be in this country. However, despite the research,
6 Department of Medicine,
University of Cape Town, demonstration projects and existing guidelines, PrEP use remains low and insufficient to
Cape Town, South Africa effectively reduce South African HIV incidence rates, with only an estimated 45 000 people
using PrEP as of June 2020. 21
7 Life Vincent Pallotti Hospital,
Cape Town, South Africa
People who have been offered PrEP and have integrated it into their daily lives describe how they
8 Department of Medicine have felt more in control of their circumstances, more free of worry and able to once again enjoy
and Infectious Diseases, their sexual intimacies in ways that have not been possible for decades given South Africa’s very
University of Cape Town,
Cape Town, South Africa high HIV prevalence. In foreign cities such as London and San Francisco and regions such as New
South Wales in Australia where universal test and treat strategies have been coupled with
extensive scale-up for PrEP, the rates of new HIV infections have dropped precipitously. It is
22
expected that with the assistance of these guidelines, further PrEP scale-up will soon be possible
in South Africa with similar positive outcomes.
9 Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Read online: 10 BARC-SA, Speciality Molecular Division, Lancet Laboratories, Johannesburg, South Africa
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Scan this QR
Scan this QR Corresponding author: Linda-Gail Bekker, [email protected]
code with your Dates: Received: 14 Aug. 2020|Accepted: 14 Aug. 2020|Published: 10 Dec. 2020
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mobile device How to cite this article: Bekker L-G, Brown B, Joseph-Davey D, et al. Southern African guidelines on the safe, easy and effective use of
pre-exposure prophylaxis: 2020. S Afr J HIV Med. 2020;21(1), a1152. https://doi.org/10.4102/sajhivmed.v21i1.1152
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Copyright: © 2020. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
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