Creating Policies, Plans and Budgets

Consider exploring the impact of introducing PrEP incrementally to existing prevention programs—and evaluate the cost of this for different populations.

Modelling Summary | PrEP and microbicide modelling study literature review

• Literature review of studies, reviews and analyses focused on the impact, cost, cost-effectiveness, drug resistance and other parameters of both PrEP and microbicides
• Modeling literature review bibliography

Sample PrEP Cost-Effectiveness Studies

• Comparative effectiveness and cost-effectiveness of antiretroviral therapy and pre-exposure prophylaxis for HIV prevention in South Africa
• Estimating the cost-effectiveness of pre-exposure prophylaxis to reduce HIV-1 and HSV-2 incidence in HIV-serodiscordant couples in South Africa
• What do we know about the cost–effectiveness of HIV preexposure prophylaxis, and is it affordable?

Sample PrEP Impact Studies

• Tailored combination prevention packages and PrEP for young key populations
• Using geospatial modelling to optimize the rollout of antiretroviral-based pre-exposure HIV interventions in Sub-Saharan Africa

In this step, you begin to assess which populations should be prioritized for PrEP introduction. This involves understanding the context of the epidemic, the characteristics of end users, and the size of the potential end user population. This is typically an iterative process that starts with collecting and understanding available data before developing new research.

You don’t need all the answers before moving ahead with the next steps for introduction. Now is the time to gather available information and identify gaps. Other questions include whether members of priority populations are willing and likely able to use PrEP consistently and, where applicable, to pay for it.

Identify Priority Populations

• Examples of situational analyses: South Africa, Kenya, Zimbabwe
• Click for a toolkit to help you get started conducting your own situational analysis: Introduction, Step 1: Data Collection, 2: PrEP Planning, 3: Summary Findings
• Building Evidence to Guide PrEP introduction for Adolescent Girls and Young Women (Population Council, 2016)
• Addressing Gender to Ensure Effective PrEP Introduction
• Guidance for Providing Informed-choice Counseling on Sexual Health for Women Interested in Pre-exposure Prophylaxis, FHI 360, Impact Research and Development Organization, Setshaba Research Centre (2015)

An estimated budget for the introduction and scale-up of PrEP to priority populations is critical. Knowing how much you think the program will cost can help structure targets and shape resource mobilization efforts with various potential funding sources.

Technical working groups will help drive strategic decision making for PrEP introduction. For guidance on setting up a TWG, click here.

In this step you synthesize the information gathered in the previous activities and use it to develop a road map for when and where PrEP will first be introduced, and how access will scale up over time. This timeline shows PrEP moving from a proof-of-concept to rollout.

Interactive PrEP Implementation Timelines

• Kenya
• South Africa

PrEP programs are supported by a range of documents. Ensuring you have the needed framework in place is an ongoing process in this initial phase of planning. Things to consider and plan for include guidelines – national-level documents that give a high-level recommendation for how PrEP should be used. Many countries are now including PrEP in their ARV guidelines, that also address how ART should be used in people living with HIV. These guidelines do not provide the detail needed for a program implementer, clinician, or service provider.

Global guidelines

• In June 2016, the WHO issued its consolidated guidelines on the use of antiretrovirals for prevention and treatment. This is the over-arching global document that is guiding country adoption of PrEP and immediate offer of ART.
• For additional related documents developed by WHO, PEPFAR and UNAIDS, click here.

Policies

Policies (also called guidance) offer more specific information about how a country’s PrEP program should look, including eligibility criteria, clinical considerations, components of the minimum package of services that should be associated with PrEP introduction, etc.

Kenya is one example of a country with a range of documents shaping the PrEP policy. These include: the Kenyan HIV Prevention Revolution Roadmap, and Kenya National Strategic Framework (KASF). Specific guidance on how PrEP should be delivered is found in the Guidelines on use of ARV drugs for treating and preventing HIV infections in Kenya – 2016 edition. You can also look national policies and guidelines from a number of countries here.