title: PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers.
abstract: HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers.
  
  
  
  Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use. A high proportion of MSM who are aware of PrEP are willing to use it. Key PrEP implementation barriers include poor knowledge about PrEP, limited access to PrEP, weak or non-existent HIV prevention programmes for MSM and other key populations, high cost of PrEP, stigma and discrimination against key populations and restrictive laws in some countries. Only several clinical trials, demonstration projects and a few larger-scale implementation studies have been implemented so far in Thailand and Australia. However, novel approaches to PrEP implementation have emerged: researcher-, facility- and community-led models of care, with PrEP services for fee and for free. The WHO consolidated guidelines on HIV testing, treatment and prevention call for an expanded access to PrEP worldwide and have provided guidance on PrEP implementation in the region. Some countries like Australia have released national PrEP guidelines. There are growing community leadership and consultation processes to initiate PrEP implementation in Asia and the Pacific.
  
  
  
  Countries of the Asia-Pacific region will benefit from adding PrEP to their HIV prevention packages, but for many this is a critical step that requires resourcing. Having an impact on the HIV epidemic requires investment. The next years should see the region transitioning from limited PrEP implementation projects to growing access to PrEP and expansion of HIV prevention programmes.
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, Australia; izablotska@kirby.unsw.edu.au.
authors.forename: Iryna
authors.initials: I
authors.lastname: Zablotska
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Grulich
authors.affiliation: The Thai Red Cross AIDS and Research Centre, Bangkok, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: The Thai Red Cross AIDS and Research Centre, Bangkok, Thailand.
authors.forename: Tarandeep
authors.initials: T
authors.lastname: Anand
authors.affiliation: Service Workers In Group Foundation, Bangkok, Thailand.
authors.forename: Surang
authors.initials: S
authors.lastname: Janyam
authors.affiliation: Asia Pacific Coalition on Male Sexual Health (APCOM), Bangkok, Switzerland.
authors.forename: Midnight
authors.initials: M
authors.lastname: Poonkasetwattana
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Rachel
authors.initials: R
authors.lastname: Baggaley
authors.affiliation: HIV Netherlands, Australia, Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Frits
authors.initials: F
authors.lastname: van Griensven
authors.affiliation: World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
authors.forename: Ying-Ru
authors.initials: YR
authors.lastname: Lo
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001208:Asia; D001315:Australia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D065129:Pre-Exposure Prophylaxis; D057545:Social Stigma; D013785:Thailand
chemical_list: D019380:Anti-HIV Agents
keywords: MSM; PrEP awareness; PrEP policy; PrEP use; demonstration studies; implementation; pre-exposure prophylaxis; the Asia-Pacific region