What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO’s recommendation on oral PrEP

Technical brief

Overview

An increasing number of countries are adopting policies endorsing PrEP for HIV prevention. Emerging evidence from clinical research that different dosing strategies can be effective provides an opportunity to offer flexibility, choice and convenience to individuals who can benefit from PrEP and is considered by WHO in updating its guidance to countries. Based on the available evidence published so far, this technical brief updates the current WHO recommendation on oral PrEP to include an option of event-driven dosing for men who have sex with men.

This technical brief aims to:

update the dosing considerations for oral pre-exposure prophylaxis (PrEP) containing TDF for men who have sex with men

summarize current evidence on the safety and efficacy of event-driven PrEP (ED-PrEP)

describe the rationale for offering ED-PrEP as an alternative to daily oral PrEP to men who have sex with men as part of comprehensive HIV prevention and sexual health services

discuss considerations for offering ED PrEP to men who have sex with men, including clear messaging on how men who have sex with men can switch from ED-PrEP to daily dosing (and vice-versa).

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