The future of pre-exposure prophylaxis (PrEP) for HIV prevention: Provider perspectives

Abstract

Background: Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on innovations in service delivery and products to inform World Health Organization (WHO) guidelines and programme implementation. Methods: 150 PrEP providers who participated in a WHO online survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted via video calls. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. Results: 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients’ needs and preferences, maintain services during COVID-19, and ensure access for hard-to-reach populations. Providers welcomed prospects of offering an CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Conclusions: Providers’ views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.