By Kerry Mangold and Ayesha Ismail, Genesis Analytics, South Africa

For far too long, post-exposure prophylaxis (PEP) in African countries has been associated solely with occupational HIV exposure and survivors of sexual violence. In Nigeria, access barriers have loomed large, as reported by its National Agency for the Control of AIDS, while Uganda has faced issues of limited access and demand for PEP, as noted by the Uganda AIDS Commission. The untapped potential of PEP in curbing new HIV acquisitions remains a critical concern, especially considering the 1.3 million new acquisitions in 2022, a figure well above the global target.

However, a promising shift is underway as national ministries of health echo calls for the “rejuvenation”, “nurturing” and “revitalization” of PEP in Kenya, South Africa and Zimbabwe, respectively. We are at a pivotal moment, channelling this collective energy to effectively implement the World Health Organization’s (WHO’s) recently revised PEP guidelines, which recommend community delivery and task sharing, ultimately aiming to get PEP closer to the people who need it.

There have been countless learnings and system successes in both community delivery and task sharing through other ARV-based prevention programmes. These must be leveraged with urgency for the PEP programme to succeed. Innovative delivery models and a swift alignment of supportive policies will be essential to make PEP more accessible; these models include online delivery, vending machines, pharmacy access and use of mobile clinics and drop-in centres with strong linkages and referrals.

Moreover, integrating PEP into the broader prevention landscape, including the services offered to key and vulnerable populations, is crucial. A promising example is Uganda’s strategic integration of PEP into routine health services alongside PrEP, HIV self-testing and sexual and reproductive health services, as part of PEPFAR’s DREAMS programme targeting adolescent girls and young women.

As more countries embark on reimagining HIV prevention strategies and capitalize on the current momentum spurred by the updated PEP guidelines, there is a pressing need to advocate for and prioritize PEP as a pivotal component of HIV prevention efforts.

Through collaborative efforts like the South-to-South HIV Prevention Learning Network (SSLN) and its i2i (insight to implementation) stream, we are documenting valuable insights and best practices on effective delivery, showcasing the translation of global directives into community-focused solutions. This collaborative platform supports countries to swiftly document, share and adapt their programmes based on regional learnings and best practices, paving the way for a more robust HIV prevention response, placing PEP in the foreground as part of the Choice agenda.