Introduction Despite progress in treatment, HIV incidence among men who have sex with men and transwomen (MSM/TW) remains high in Peru due to low coverage and insufficiency of HIV prevention services. In 2014–2015 a study gathered evidence for implementing combination HIV prevention for MSM/TW in collaboration with the health sector and civil society.

Methods In 6 cities, a mixed-methods study: (1) identified stakeholders` (users, providers) perspectives on existing and novel (pre-exposure prophylaxis [PrEP], Treatment as Prevention [TasP]) HIV prevention methods; (2) assessed health systems` needs and conditions, and (3) used a previously developed mathematical model to estimate impact and cost-effectiveness of combinations of 5 interventions (2 behavioural, 2 treatment-focused, PrEP) to reduce HIV incidence among MSM/TW in general and TW sex workers in particular. A National Consultation on Combination Prevention allowed for discussion of preliminary findings.

Results According to the stakeholders` analysis, information on new combination prevention tools was limited among communities and providers alike, particularly for TasP (as PrEP trials had taken place here); misconceptions led to fear/resistance to change. Health facilities required improvements (lab access, training) to respond to new needs. The specific TW sex worker model predicted higher effectiveness for various combinations of prevention strategies. In PrEP-contaning scenarios, PrEP made a distinct contribution, yet cost-effectiveness was largely determined by drug cost. It seemed higher if PrEP was used on a smaller group at higher risk. (MSM/TW analysis is ongoing). The National Consultation showed increasing interest in PrEP/TasP among potential users and providers.

Conclusion Focused PrEP use may play a significant role in combined HIV prevention in Peru if TDF-FTC is obtained at reasonable cost.