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

Abstract

Background: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods: We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings.Conclusions: A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.

Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

“…The unique situation of reduced physical contact and a societal lockdown may be a good opportunity to consider alternative forms of PrEP follow-up and sexual health services, such as online counselling or home-based sampling. 22 Additionally, we suggest further research is needed to investigate what minimum package for PrEP follow-up would be feasible and for whom.…”

Expanding the Pie–Differentiated PrEP Delivery Models to Improve PrEP Uptake in the San Francisco Bay Area

“…A recent review of delivery models for HIV prevention found only one dedicated study of PrEP delivery for trans women. 30 Our study provides evidence that PrEP uptake for trans communities could be enhanced by offering low threshold PrEP-only services outside primary care, messaging building on the facilitators we identified, and attending to structural barriers to PrEP. Furthermore, the barriers to PrEP uptake identified in the literature to date are only partially relevant-based on our evidence.…”

A Demedicalized Model to Provide PrEP in a Sexual Health Clinic

“…An ongoing national CDC learning collaborative includes 31 SHCs, 24 (77%) of which provide PrEP prescriptions to patients (CDC program data, personal communication). Although different models for PrEP implementation in SHCs have been described, 8,9 best practices for real-world integration of PrEP services into SHCs are ill defined. Ideally, PrEP should be readily accessible to patients, affordable, and implemented without disrupting other SHC services or placing unsustainable new demands on clinician time.…”