Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

Abstract

Objectives: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. Design: Systematic review and narrative synthesis. Methods: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: This review identified 16 studies published between 2018 and 2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP, and mail-in testing. Conclusions: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g. pharmacist prescribers), as well as the settings of PrEP care (i.e. telePrEP) and laboratory screening (i.e. mail-in testing) may increase PrEP access and care delivery.

Using an innovative method for self-collection of capillary blood for HIV and syphilis testing among men who have sex with men who use PrEP in the Netherlands; Limburg4zero

“…To date, few non-commercial, home-based sexual health care programs are accessible for PrEP users 6,7 . Several methods for self-sampling have been validated, such as self-collected anorectal and pharyngeal swabs and urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing, and self-collection of dried bloodspot or whole blood via fingerprick for HIV and Treponema pallidum (syphilis) serology testing 8–11 .…”