The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review

Mistler, Colleen; Copenhaver, Michael; Shrestha, Roman

doi:10.1007/s10461-020-02988-x

Cited by 62 publications

(66 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As for PWID, which present some of the lowest percentages of knowledge and use in the sample, little attention has been given to PEP and PrEP knowledge and use in this community (35). A recent systematic review (36) of PrEP in this group revealed high awareness but low usage rates, ranging from 0 to 3%. The low knowledge levels of PrEP and PEP found among PWID in this study suggest a need to invest in increasing awareness of the tool among this group, and the level of use reinforces the urgency of adequately including PWID in PrEP programs, as well as information and ease of access to PEP.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Simões

Meireles

Rocha³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

Background: Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) have been increasingly available in Europe. Due to the high burden of HIV in key populations, these could benefit from their use. In 2016, in Portugal, an open, non-interval, prospective cohort study was established in a network of 26 community-based voluntary HIV/STI counseling and testing centers. Data collected included questions on PEP and PrEP knowledge and use. We aimed to estimate the proportion of PEP and PrEP knowledge and its use among key populations, visiting the centers between 2016 and 2019.Method and results: Individuals who self-identify as being among at least one key population for HIV, men who have sex with men (MSM), people who inject drugs (PWID), sex workers (SW), migrants, and male-to-female transgender individuals (MTF), responded to questions on PEP and PrEP knowledge and use while waiting for their test results between 2016 and 2019 (n = 12,893 for PEP; n = 10,973 for PrEP). Reported knowledge was low in all key populations for both tools: 15.7% of respondents reported knowing about PEP and 10.9% about PrEP over the course of 4 years. PEP was used by 1.8% and PrEP by 0.4% of the respondents, MSM being 88.9% of PrEP users, and 52.8% of PEP users. Multivariate logistic regression showed multiple factors associated with knowing the tools, including age, education, country of birth, gender, year of test, having a reactive HIV test in the same visit, reporting an STI or condomless sex in the last 12 months, and identifying with being MSM or SW.Conclusions: Knowledge and use of PEP and PrEP remain low among key populations in Portugal. The need remains to increase knowledge and use among those at risk for HIV infection.

show abstract

Section: Discussionmentioning

confidence: 99%

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Simões

Meireles

Rocha³

et al. 2021

Front. Public Health

View full text Add to dashboard Cite

show abstract

“…Few people who inject drugs and people who live in prison were reported to have received PrEP, supporting findings of a systematic review that PrEP use among people who inject drugs is low. 25 In mathematical modelling studies, focusing on priority populations with typically higher HIV incidence rates than the general population is most cost-effective, 26 and these populations are often prioritised in PrEP policies. Moreover, observational studies in high-income settings suggest that provision of PrEP to key populations, and achieving high coverage, has contributed to population-level reduction in HIV incidence.…”

Section: Discussionmentioning

confidence: 99%

Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study

et al. 2021

View full text Add to dashboard Cite

Background In 2016, the UN General Assembly set a global target of 3 million oral pre-exposure prophylaxis (PrEP) users by 2020. With this target at an end, we aimed to assess global trends in the adoption of WHO PrEP recommendations into national guidelines and numbers of PrEP users, defined as people who received oral PrEP at least once in a given year, and to estimate future trajectories of PrEP use. Methods In this global summary and forecasting study, data on adoption of WHO PrEP recommendations and numbers of PrEP users were obtained through the Global AIDS Monitoring system and WHO regional offices. Trends in these indicators for 2016-19 by region and for 2019 by country were described, including by gender and priority populations where data were available. PrEP user numbers were forecasted until 2023 by selecting countries with at least 3 years of PrEP user data as example countries in each region to represent possible future PrEP user trajectories. PrEP user growth rates observed in example countries were applied to countries in corresponding regions under different scenarios, including a COVID-19 disruption scenario with static global PrEP use in 2020. Findings By the end of 2019, 120 (67%) of 180 countries with data had adopted the WHO PrEP recommendations into national guidelines (23 in 2019 and 30 in 2018). In 2019, there were about 626 000 PrEP users across 77 countries, including 260 000 (41•6%) in the region of the Americas and 213 000 (34•0%) in the African region; this is a 69% increase from about 370 000 PrEP users across 66 countries in 2018. Without COVID-19 disruptions, 0•9-1•1 million global PrEP users were projected by the end of 2020 and 2•4-5•3 million are projected by the end of 2023. If COVID-19 disruptions resulted in no PrEP user growth in 2020, the projected number of PrEP users in 2023 is 2•1-3•0 million. Interpretation Widespread adoption of WHO PrEP recommendations coincided with a global increase in PrEP use. Although the 2020 global PrEP target will be missed, strong future growth in PrEP use is possible. New PrEP products could expand the PrEP user base, and, with greater expansion of oral PrEP, further adoption of WHO PrEP recommendations, and simplified delivery, PrEP could contribute to ending AIDS by 2030. Funding Unitaid, Bill & Melinda Gates Foundation, and WHO.

show abstract

Section: Introductionmentioning

confidence: 99%

“…16 Regions of the South are also vulnerable to injection drug use-associated HIV transmission, in part due to limited availability of harm reduction programs and disproportionately low PrEP use among PWID. [17][18][19] Among the priority geographic areas identified in the U.S. EHE initiative, 6 of the 7 states with high rural HIV burdens and 23 of the 48 high HIV burden counties are in the South. 20 Despite the need to characterize unique aspects of the U.S. South that may limit PrEP provision, most provider surveys have not specifically targeted Southern healthcare providers.…”

Section: Introductionmentioning

confidence: 99%

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Moore

Kelly

Alexander

et al. 2020

J Prim Care Community Health

View full text Add to dashboard Cite

Introduction/Objectives: Pre-exposure prophylaxis (PrEP) use in the southern United States is low despite its effectiveness in preventing HIV acquisition and high regional HIV prevalence. Our objectives were to assess PrEP knowledge, attitudes, and prescribing practices among Tennessee primary care providers. Methods: We developed an anonymous cross-sectional electronic survey from March to November 2019. Survey development was guided by the Capability, Opportunity, Motivation, and Behavior framework and refined through piloting and interviews. Participants included members of professional society and health center listservs licensed to practice in Tennessee. Respondents were excluded if they did not complete the question regarding PrEP prescription in the previous year or were not in a position to prescribe PrEP (e.g., hospital medicine). Metrics included PrEP prescription in the preceding year, PrEP knowledge scores (range 0-8), provider attitudes about PrEP, and provider and practice characteristics. Knowledge scores and categorical variables were compared across PrEP prescriber status with Wilcoxon rank-sum and Fisher’s exact tests, respectively. Results: Of 147 survey responses, 99 were included and 43 (43%) reported PrEP prescription in the preceding year. Compared with non-prescribers: prescribers had higher median PrEP knowledge scores (7.3 vs 5.6, P < .01), a higher proportion had self-reported patient PrEP inquiries (95% vs 21%, P < .01), and a higher proportion had self-reported good or excellent ability to take a sexual history (83% vs 58%, P = .01) and comfort taking a sexual history (92% vs 63%, P < .01) from men who have sex with men, a subgroup with high HIV risk. Most respondents felt obligated to provide PrEP (65%), and felt all primary care providers should provide PrEP (63%). Conclusion: PrEP provision is significantly associated with PrEP knowledge, patient PrEP inquiries, and provider sexual history taking ability and comfort. Future research should evaluate temporal relationships between these associations and PrEP prescription as potential routes to increase PrEP provision.

show abstract

The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review

Cited by 62 publications

References 47 publications

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Knowledge and Use of PEP and PrEP Among Key Populations Tested in Community Centers in Portugal

Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study

Tennessee Healthcare Provider Practices, Attitudes, and Knowledge Around HIV Pre-Exposure Prophylaxis

Contact Info

Product

Resources

About