# HIV-1 Prevalence and Oral Pre-Exposure Prophylaxis Effectiveness and Prevalence of Use Among Key Populations in High-Income Economies (2017–2023): A Systematic Review and Meta-Analysis of Real-World Studies

## TL;DR

This study reviews real-world data on HIV-1 prevalence and PrEP use in key populations across high-income countries, showing high PrEP effectiveness but uneven access.

## Contribution

The study provides a global meta-analysis of real-world HIV-1 and PrEP data in key populations outside the US and Africa.

## Key findings

- Global HIV-1 prevalence in key populations was 5.1%, with significant regional variation.
- PrEP users had an HIV-1 prevalence of <0.4%, showing high real-world effectiveness.
- PrEP use varied widely, with 18.2% global prevalence among key populations.

## Abstract

In this systematic literature review and meta-analysis, real-world data from high-income economies (excluding the US and Africa) on HIV-1 epidemiology (2019–2023), oral pre-exposure prophylaxis (PrEP) effectiveness (2017–2023), and prevalence of oral PrEP use (2017–2023) were assessed in key populations disproportionately affected by HIV-1. Overall, 204 unique data sources were identified from 38 high-income economies. In key populations, the pooled global HIV-1 prevalence estimate was 5.1% (95% confidence interval: 4.2%–6.1%), ranging from 0.2% in South Korea to 28.9% in Romania. Pooled global prevalence was lowest in transgender men (1.4%) and people in prison (2.2%); 7.0%–7.8% in men who have sex with men, people who inject drugs, sex workers, and transgender women; and highest in individuals who were in multiple key populations (19.4%). Global prevalence of oral PrEP use was 18.2% among key populations, with HIV-1 prevalence <0.4% in PrEP users, indicating high PrEP effectiveness. Targeted prevention strategies are needed to provide global equitable PrEP access and reduce HIV-1 acquisition.

HIV-1 prevalence ranged from <1% to 29% across high-income economies and varied among key populations within regions. Pre-exposure prophylaxis was highly effective in real-world settings, but its use varied widely across populations and regions, highlighting the need for equitable access.