Implementing HIV pre-exposure prophylaxis (PrEP): let's not get caught with our pants down.

HIV pre-exposure prophylaxis (PrEP) is a daily pill that prevents HIV acquisition. In March 2018, New Zealand became one of the first countries in the world to publicly fund PrEP for individuals at high risk. PrEP promises significantly improved HIV control but is unfamiliar to most health practitioners here, compromising its potential. In this article we review the rationale for PrEP and identify barriers to rapid implementation. The latter include: consumer and health practitioner awareness; acceptability; scale-up targets; prescribing and pharmacy bottlenecks; service capacity to manage follow-up; primary care training; monitoring systems for uptake and quality; equity; eligibility; risk compensation and policy. Many of these areas are ripe for research and innovation. By addressing these obstacles we can realise the potential of PrEP and move closer to ending HIV in Aotearoa/New Zealand.