Pre-exposure prophylaxis (PrEP) with antiretrovirals could prevent millions of infections, yet effective strategies to get PrEP delivered are just being defined. This editorial introduces a series of 17 articles which form a special issue of Sexual Health focused on the opportunities and challenges for health service providers engaged in PrEP prescribing. All pieces presented here share useful lessons from PrEP pioneers; more than that, they should serve as catalysts to accelerate PrEP implementation around the world.

If pre-exposure prophylaxis (PrEP) is to have a public health impact, wider strategic use needs to be achieved. Setting coverage targets can guide the introduction of PrEP programmes for maximum effect on the HIV epidemic. PrEP targets should be set based on the estimated population size of people at substantial risk of HIV infection, the likely uptake patterns and the capacity to provide services.

This article presents the 2018 status of policy guidance for the use of pre-exposure prophylaxis (PrEP) during peri-conception, pregnancy and breastfeeding, particularly looking at countries with high HIV prevalence, including those in sub-Saharan Africa. Pregnancy was often recognized as a period with elevated HIV risk but few PrEP guidance documents have a recommendation specific to PrEP use among pregnant women. As PrEP implementation becomes more widespread across the globe, countries can include guidance for women during peri-conception, pregnancy, and breastfeeding.

Pre-exposure prophylaxis (PrEP) is an exciting new tool for HIV prevention, but uptake of PrEP has been limited. We discuss why PrEP has not reached many people who need it and give examples of new ways to get PrEP to those who need it most. PrEP is a critical part of comprehensive HIV prevention programs, and further innovative approaches to promote equitable PrEP uptake are needed.

In Victoria, the PrEPX study was launched in 2016 to evaluate the effect of large-scale delivery of HIV pre-exposure prophylaxis (PrEP). The Melbourne Sexual Health Centre is the only sexual health service in Victoria and is one of the participating sites for the PrEPX. We found that the increase in number of medical consultations required for the PrEPX study did not result in increased demand for public sexual health service.

Creating alternative and innovative models of care for people to access HIV pre-exposure prophylaxis (PrEP) will be critical to the effort of reducing new HIV infections. The very first ever pharmacist-managed HIV PrEP clinic in a community pharmacy was successfully created in Seattle, WA, USA, to provide these services. This highly successful program demonstrates that implementing a similar program in other community pharmacies across the nation could drastically increase access to PrEP.

In a survey of transgender women (TW) in Detroit, USA, many participants reported HIV risk factors consistent with pre-exposure prophylaxis (PrEP) recommendation guidelines. Interest in PrEP among high-risk TW who were not already taking PrEP was low. Specialised clinical infrastructure that is responsive to the specific needs of TW may be needed to expand PrEP to this oftentimes marginalised and high-risk population.

Kenya is the first African country to rollout pre-exposure prophylaxis nationwide in the public sector. This paper shares Kenya’s planning process, challenges, lessons learnt and progress made. This case study will provide guidance for low- and middle-income countries planning the rollout of pre-exposure prophylaxis in response to both a generalised and concentrated epidemic.

People at greatest risk for HIV exhibit low levels of using pre-exposure prophylaxis (PrEP), a highly effective intervention for preventing HIV infection. The aim of this study was to evaluate currently available mobile apps, finding that apps currently on the market demonstrate potential in contributing to PrEP uptake. The results from this study can inform app recommendations to high-risk people to avert additional HIV infections.

Allowing nurses to supply and monitor use of the highly effective HIV prevention drug, pre-exposure prophylaxis (PrEP) has the potential to significantly reduce HIV transmission by getting the drug to more people at high risk of HIV. An Australian trial using nurse-led PrEP delivery has shown the practice is safe and effective and could potentially be used more widely

56 Dean Street, a large sexual helath clinic in London (UK), has implemented a dedicated path to follow-up pre-exposure prophylaxis (PrEP) users, given the increasing need for such services. This article gives an outlook on the interventions required and the obstacles faced in the setting up of a service for PrEP users in a national health service context.

Pre-exposure prophylaxis is an effective but underutilized tool for HIV prevention; one barrier to implementation is awareness of medical providers. Investigators launched a longitudinal distance telementorship program to connect community health practitioners to academic specialists and incorporated regular pre-exposure prophylaxis trainings and case discussions. They found that this intervention helped practitioners stay up to date on national guidelines and increased their likelihood to prescribe pre-exposure prophylaxis to at-risk patients.

Pre-exposure prophylaxis holds substantial promise to reduce the number of HIV infections, but part of its success will depend on healthcare providers’ willingness to provide it. With an online survey among Belgian healthcare providers we found that HIV specialists consistently reported having better knowledge of PrEP, less concerns and a more accepting attitude towards PrEP than primary care physicians. Although HIV specialists may be better positioned to provide PrEP, additional training and guidelines to involve primary care physicians is warranted.