Correlations Between Oral Pre-exposure Prophylaxis Initiations and Policies, 2021

Policies facilitating access to HIV prevention services, specifically for pre-exposure prophylaxis (PrEP), can foster enabling environments for service uptake. This analysis aims to establish whether policies enabling broad PrEP eligibility, HIV self-testing, and lowered age of consent to HIV testing and treatment services are correlated with PrEP uptake. Ages of consent vary by country, therefore this analysis focused on how age of consent policies, in general, affect adolescent PrEP uptake. Data was collected from the HIV Policy Lab and AVAC’s Global PrEP Tracker, a database of approximately 180 PrEP projects operating across 95 countries, and linear regression and correlation analyses were conducted via STATA to examine relationships amongst national oral PrEP eligibility, HIV self-testing, lowered age of consent, and national cumulative oral PrEP initiations, as of December 2021. Of all 194 countries tracked by the HIV Policy Lab, only about 7% have adopted all three policies (HIV self-testing, lowered age of consent, and PrEP eligibility policies). Less than 50% have adopted have adopted at least one of these policies. Of the 54 countries that have fully adopted PrEP eligibility policies, less than 30% have co-adopted HIV self-testing or lowered age of consent policies. About 30% of these 194 countries have yet to adopt any of these policies, of which about 14% have indicated information is “unavailable” for at least one of the policies. Analyses conducted for the 91 countries tracked by both the HIV Policy Lab and the Global PrEP Tracker revealed a significant and positive relationship between cumulative individuals initiated on oral PrEP and adoption of HIV self-testing policies (p=0.01, r=0.26), lowered age of consent policies (p=0.01, r=0.25), and PrEP eligibility policies (p=0.01, r=0.26). Stronger advocacy efforts towards approving public health policies, such as those outlined in our analysis, that enshrine and enable access to HIV prevention are necessary.

促进HIV预防服务获取的政策，特别是针对暴露前预防（pre-exposure prophylaxis，PrEP）的政策，能够为服务利用营造有利环境。本分析旨在确定，使PrEP资格范围扩大、HIV自我检测（HIV self-testing）得以实施以及HIV检测与治疗服务知情同意年龄（age of consent）降低的政策是否与PrEP利用相关。知情同意年龄因国家而异，因此本分析聚焦于知情同意年龄政策总体上如何影响青少年PrEP利用。数据来源于HIV政策实验室（HIV Policy Lab）和AVAC全球PrEP追踪数据库（AVAC’s Global PrEP Tracker）——该数据库收录了95个国家约180个正在开展的PrEP项目；截至2021年12月，通过STATA软件进行线性回归（linear regression）和相关性分析（correlation analysis），以探究国家层面口服PrEP资格政策、HIV自我检测政策、知情同意年龄降低政策与全国口服PrEP累计启动人数之间的关系。在HIV政策实验室追踪的194个国家中，仅约7%已采纳全部三项政策（HIV自我检测、知情同意年龄降低及PrEP资格政策）；不足50%的国家已采纳至少其中一项政策。在54个已全面采纳PrEP资格政策的国家中，不足30%同时采纳了HIV自我检测或知情同意年龄降低政策。这194个国家中约30%尚未采纳任何上述政策，其中约14%表示至少有一项政策的信息“不可获取”。对同时被HIV政策实验室和全球PrEP追踪数据库覆盖的91个国家开展的分析显示，口服PrEP累计启动人数与HIV自我检测政策采纳（p=0.01，r=0.26）、知情同意年龄降低政策采纳（p=0.01，r=0.25）及PrEP资格政策采纳（p=0.01，r=0.26）之间存在显著正相关关系。有必要加大倡导力度，推动批准那些如本分析所述、旨在确立并保障HIV预防服务获取的公共卫生政策。