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Pre-exposure prophylaxis (PrEP) with antiretroviral agents to prevent human immunodeficiency virus (HIV) acquisition is now a standard of care in many countries. After more than a decade of research and dozens of randomised trials, it is clear that PrEP is both safe and efficacious. Oral PrEP is thus a key component of an HIV prevention package and should be offered to anyone who may be exposed to HIV, whether sexually or through other means. With the highest HIV incidence in the world, PrEP use in the South African population remains unacceptably low and insufficient to reach its full impact as an HIV control measure. To realise the full value of this prevention tool, PrEP must become more accessible. Therefore, the updated 2020 PrEP guidelines have (1) broadened eligible groups to include pregnant and breastfeeding women, (2) reduced clinical and health system barriers to simplify PrEP initiation and administration (e.g. same-day PrEP), (3) broadened PrEP delivery to include on-demand PrEP in men who have sex with men and transgender women, (4) provided updates of adverse events and relevant drug–drug interactions and (5) suggested parameters with which to measure PrEP rollout and success.

Southern African guidelines on the safe, easy and effective use of pre-exposure prophylaxis: 2020