Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming

Abstract

Pre-exposure prophylaxis (PrEP) is an evidence-based new biomedical HIV prevention intervention, which involves the pre-emptive use of daily (or event-based) antiretroviral drugs, to reduce risk of HIV acquisition if exposed. PrEP has recently been positioned as an integral prevention tool to reduce HIV acquisition risk among men who have sex with men (MSM) at country-level and within global prevention strategies. Given this global scale up of PrEP, we conducted a scoping review of extant international literature documenting service related perspectives, models and lessons learnt in PrEP programming for MSM. A systematic search of literature was conducted, and restricted to English language records in the timeframe 2008 to February 2019. Eligibility criteria centered on whether studies broadly described PrEP programming and service delivery for MSM as well as health communication. Following exclusion of ineligible records and removal of duplicates, 84 records were charted and thematically analysed according to scoping review methods. Four themes emerged from the thematic analysis of data; ‘PrEP service aspects, settings and staff’; ‘PrEP prescriber experiences, therapeutic alliance and care planning’; ‘PrEP adherence within formal service structures’; and ‘Multi-disciplinary and innovative PrEP care pathways’. The review highlights the complexities in providing optimal PrEP services for MSM by mapping and illustrating the importance of understanding the informal and formal routes to PrEP use among this HIV risk population; the barriers to uptake; the requirement for the presence of a positive therapeutic alliance between patient and prescriber in supporting patient initiation and adherence to PrEP regimes; and the need for availability in different culturally and ethnically sensitive models of PrEP service delivery according to low to high risk groups within the MSM communities.

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“…This broad range of possible PrEP service delivery models was not only the result of care being adapted to users' needs, as was also found in a recent scoping review by Hillis et al [55]. This was also due to care being organised in an efficient way, using resources that were already available to address certain target groups.…”

“…In the majority of the reports, PrEP was delivered through in-person visits by a provider in a given physical setting. Yet, we also identified the use of mobile applications (mHealth) and telemedicine as strategies to overcome issues of accessibility to regular health care services, as also mentioned by Hillis et al [34,42,45,55]. Moreover, these strategies were also applied to empower individuals' active involvement in their own health status [22][23][24]52].…”

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“…This broad range of possible PrEP service delivery models was not only the result of care being adapted to users' needs, as was also found in a recent scoping review by Hillis et al [55]. This was also due to care being organised in an e cient way, using resources that were already available to address certain target groups.…”

“…setting. Yet, we also identi ed the use of mobile applications (mHealth) and telemedicine as strategies to overcome issues of accessibility to regular health care services, as also mentioned by Hillis et al [30,42,48,55]. Moreover, these strategies were also applied to empower individuals' active involvement in their own health status [39,[44][45][46].…”

“…insurance schemes and reimbursement policies) , the legal and policy structures in which PrEP delivery operates, and the speci c content and data and monitoring systems of PrEP care programs. Yet, some of these topics were recently reviewed elsewhere [55].…”