Creating Policies, Plans and Budgets

A step-by-step framework for planning the introduction of PrEP


value chain graphic

For PrEP to have impact, programs need to be well designed and resourced. The first step involves answering questions such as: who is at highest risk for HIV infection and to whom will PrEP be targeted? How much will this cost? Where will resources for prevention investments come from? Then, this information can shape national guidelines and policies on PrEP.

Demonstration Planning

Beginning in 2013, the Bill & Melinda Gates Foundation supported seven early oral PrEP demonstration projects. The Prevention Market Manager project aggregated and analyzed the project results to inform oral PrEP rollout and new product demonstration projects. Click here for the findings.

Two companion documents, Lessons from Seven Early Oral PrEP Demonstration Projects and What We Learned About Oral PrEP Delivery from Early Demonstration Projects, are also available.

Identify priority populations

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

Establish a Technical Working Group (TWG)

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

Create an implementation plan and timeline

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.

Country Implementation Plans

Interactive PrEP Implementation Timelines

Develop policies and guidelines

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.

National policies and guidelines from a number of countries are available here.

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.

OPTIONS Plan 4 PrEP

The Plan 4 PrEP Toolkit supports national planning for the rollout of oral PrEP. Implementers may use all the steps to guide the entire planning process or use specific sections. Policy makers, technical working groups, implementing partners or advocates at the national or sub-national level will find tools informed by experiences in PrEP rollout from South Africa, Kenya and Zimbabwe.

Engage the private sector

Help Desk

Need answers? The PrEPWatch Help Desk provides support for all your questions related to PrEP implementation and planning.

Last updated on May 2, 2019.