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Clinical trial data have shown that oral pre-exposure prophylaxis (PrEP) is efficacious when taken as prescribed; however, PrEP adherence is complex and must be understood within the context of variable risk for HIV infection and use of other HIV prevention methods. Different levels of adherence may be needed in different populations to achieve HIV prevention, and the optimal methods for achieving the necessary adherence for both individual and public health benefits are unknown. Guidance for PrEP use must consider these questions to determine the success of PrEP-based HIV prevention programs. In this article, we propose a new paradigm for understanding and measuring PrEP adherence, termed prevention-effective adherence, which incorporates dynamic HIV acquisition risk behaviors and the use of HIV alternative prevention strategies. We discuss the need for daily PrEP use only during periods of risk for HIV exposure, describe key issues for measuring and understanding relevant behaviors, review lessons from another health prevention field (i.e., family planning), and provide guidance for prevention-effective PrEP use. Moreover, we challenge emerging calls for sustained, near perfect PrEP adherence regardless of risk exposure and offer a more practical and public health-focused vision for this prevention intervention.

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and city or county jurisdictions independently funded for HIV surveillance: California (including Los Angeles County and San Francisco), District of Columbia, Georgia, Illinois (including Chicago), and New York (excluding New York City).preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.Eight health departments matched probable and confirmed cases of monkeypox † diagnosed through July 22, 2022, and occurring among persons aged ≥18 years, to local HIV and STI surveillance data using individually established methods that included various personal identifiers (e.g., name, † https://www.cdc.gov/poxvirus/monkeypox/clinicians/case-definition.html INSIDE