Abstract
IntroductionIn the Asia‐Pacific, pre‐exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. The best delivery models and strategies for broadening access of the vulnerable communities are not fully known. This review identified PrEP programmes reported in the Asia‐Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework.MethodsWe performed a literature search on PubMed and Ovid MEDLINE using relevant search terms, manual searched grey literature by visiting relevant websites, examined reference lists and contacted authors for clarification of included PrEP programmes reported through July 2019. A structured table was used for data extraction and summarizing findings in accordance with the five constructs of approachability, acceptability, availability, affordability and appropriateness grounded in the conceptual framework of Healthcare Accessibility.Results and discussionThis literature search yielded a total of 1308 publications; 119 full texts and abstracts were screened, and 24 publications were included in the review. We identified 11 programmes implemented in seven cities/countries in the Asia‐Pacific. A typology of four PrEP delivery models was delineated: (a) fee‐based public service model; (b) fee‐based community setting model; (c) free public service model; and (d) free community setting model. Overall, the free community setting model was most commonly adopted in the Asia‐Pacific, with the strength to boost the capacity of facility and human resources, which enhanced “approachability”, “availability” and “acceptability.” The free public service model was characterized by components designed in improving “approachability,” “availability” and “appropriateness,” with attention on equity in accessing PrEP. Among free‐based models, long‐term affordability both to the government and PrEP users would need to be maximized to increase accessibility. Alongside the need for raising awareness, supportive environments and ensuring timely access were means for enabling the development of a sustainable PrEP service.ConclusionPrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia‐Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed.
Highlights
In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited
This literature search yielded a total of 1308 publications, 1231 of which were identified through electronic search (787 from PubMed and 444 from Ovid MEDLINE), plus a further 77 by manual search from the grey literature
The typology distinguishes two core dimensions of PrEP services in the 11 programmes: financing that divides free-of-charge versus outof-pocket payment required for the services, and access points that divides public hospital/clinics versus community settings, which involved a range of settings including private clinics and those operated by communitybased organization (CBO)
Summary
In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. This review identified PrEP programmes reported in the Asia-Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework. While PrEP has been introduced to reduce the vulnerability to HIV infection in some places, the best delivery models and factors leading to their success, are not fully known. The Levesque framework refined previous ones by specifying five key constructs: approachability, acceptability, availability, affordability and appropriateness, and with five corresponding abilities attributed to service users: ability to perceive, to seek, to reach, to pay and to engage [24] This framework has been applied in a range of healthcare contexts for analysis [25-27]. We set out to identify PrEP delivery models in the Asia-Pacific, and chose the Levesque framework to assess their strengths and weaknesses through the five constructs to understand healthcare access from multiple levels
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