Implications of all the available evidence
Understanding dosing requirements for insertive sex is necessary to provide guidance for optimal use. The high concentration of protection found in this study of foreskins from men in Uganda and South Africa provides for the data for insertive sex in men from SSA. Our data suggest that on-demand PrEP could be simplified to a double dose of F/TDF or F/TAF given 5–21 h prior to intercourse. The limited efficacy of TFV-FTC or TAF-FTC as PEP when initiated 48 h after HIV exposure supports evidence from rectal tissue that PEP initiation should be within 48 h of potential exposure to HIV.