Demand creation for primary biomedical prevention: identifying lessons across interventions to inform daily oral preexposure prophylaxis programs.

PURPOSE OF REVIEW: At a moment when UNAIDS (Joint United Nations Programme on HIV/AIDS) has acknowledged a 'prevention crisis,' and multiple countries and implementers are emphasizing 'user-centered' and/or differentiated models of delivering HIV treatment and prevention, it is essential to understand and act on best practices from all relevant interventions to create effective oral preexposure prophylaxis (PrEP) programs.

RECENT FINDINGS: It is possible to adapt private sector approaches to understanding and segmenting the preferences and mindsets of potential consumers to primary HIV prevention programs, as demonstrated by a voluntary medical male circumcision (VMMC)-focused intervention that successfully trained and supported counselors to identify and deliver tailored messages to men potentially undergoing VMMC. Literature on PrEP and demand creation is less extensive and suggests uneven application of user-centered design and demand-side thinking; a recent analysis of condom programing demonstrates that failure to maintain resources for social marketing can drive a collapse in use and an increase in HIV incidence.

SUMMARY: Approaches to demand creation for primary prevention are dynamic and evolving. However, the lag between implementation and publication means that there is a paucity of PrEP-specific information. Insights from VMMC and other strategies can and must be considered as part of a more holistic approach to increasing demand for primary prevention interventions.