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

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.