Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review

Abstract

BackgroundPre-exposure prophylaxis (PrEP) is an emerging biomedical prevention intervention. Documenting PrEP service delivery models (SDMs) that promote linkage to and continuation of PrEP will inform guidelines and maximise roll-out.ObjectivesTo synthesise and appraise the effectiveness and feasibility of PrEP SDMs designed to promote linkage to PrEP care among adolescent girls and young women (AGYW) and men in sub-Saharan Africa (SSA).Eligibility criteriaPrimary quantitative and qualitative studies published in English and conducted in SSA were included. No restrictions on the date of publication were applied.Sources of evidenceMethodology outlined in the Joanna Briggs Institute reviewers’ manual was followed. PubMed, Cochrane library, Scopus, Web of Science and online-conference abstract archives were searched.Charting methodsData on article, population, intervention characteristics and key outcomes was charted in REDCap.Results and conclusionOf the 1204 identified records, 37 (met the inclusion criteria. Health facility-based integrated models of PrEP delivery with family planning, maternal and child health or sexual and reproductive services to AGYW resulted in PrEP initiation of 16%–90%. Community-based drop-in centres (66%) was the preferred PrEP outlet for AGYW compared with public clinics (25%) and private clinics (9%). Most men preferred community-based delivery models. Among individuals who initiated PrEP, 50% were men, 62% were <35 years old and 97% were tested at health fairs compared with home testing. Integrated antiretroviral therapy (ART)-PrEP delivery was favoured among serodiscordant couples with 82.9% of couples using PrEP or ART with no HIV seroconversions. PrEP initiation within healthcare facilities was increased by perceived client-friendly services and non-judgemental healthcare workers. Barriers to PrEP initiation included distance to travel to and time spent at health facilities and perceived community stigma. PrEP SDMs for AGYW and men need to be tailored to the needs and preferences for each group. Programme implementers should promote community-based SDMs to increase PrEP initiation among AGYW and men.

Barriers to the uptake of oral pre-exposure prophylaxis among young key populations in Nigeria

“…Interventions to improve access of YKP to PrEP should include creating awareness about where PrEP can be accessed, expanding the number of OSS, integrating PrEP into community outreach programs, and engaging community pharmacists for PrEP provision. [20][21][22][23] Compared with other KP groups, MSM mostly cited lack of interest in PrEP as the main barrier to never using PrEP. This is contrary to findings especially from high-income countries, that have highlighted high interest of MSM in PrEP.…”

“…Interventions to improve access of YKP to PrEP should include creating awareness about where PrEP can be accessed, expanding the number of OSS, integrating PrEP into community outreach programs, and engaging community pharmacists for PrEP provision. 20–23…”

Pre-exposure prophylaxis (PrEP) knowledge, use, and discontinuation among Lake Victoria fisherfolk in Uganda: a cross-sectional population-based study

“…While most prior PrEP implementation studies in Africa have focused on girls and women, our findings underscore the need to tailor service delivery for men. Differentiated PrEP delivery models that include out-of-clinic options, event driven PrEP, multi-month dispensing and long-acting PrEP options (such as cabotegravir) could improve PrEP uptake among men, adolescents, and other mobile groups in Lake Victoria fishing communities (28,29).…”

Perspectives of female sex workers on HIV pre-exposure prophylaxis delivery in Uganda: A qualitative study

“…Whereas differentiated PrEP service delivery is effective for adolescent girls and young women 15,16 , FSW experience unique challenges, including multiple sexual partners, inconsistent condom use, intersecting stigmas, discrimination by healthcare providers, limited access to education, inconvenient clinic operating hours, high costs of travelling to healthcare facilities, criminalization of sex work and high levels of alcohol and drug misuse 17 . This qualitative study aimed to explore FSWs' experiences in accessing PrEP through existing community and facility PrEP delivery models in Uganda to better understand how well these models met their prevention needs.…”