Abstract
Pre-exposure prophylaxis (PrEP) is an evidence-based new biomedical HIV prevention intervention, which involves the pre-emptive use of daily (or event-based) antiretroviral drugs, to reduce risk of HIV acquisition if exposed. PrEP has recently been positioned as an integral prevention tool to reduce HIV acquisition risk among men who have sex with men (MSM) at country-level and within global prevention strategies. Given this global scale up of PrEP, we conducted a scoping review of extant international literature documenting service related perspectives, models and lessons learnt in PrEP programming for MSM. A systematic search of literature was conducted, and restricted to English language records in the timeframe 2008 to February 2019. Eligibility criteria centered on whether studies broadly described PrEP programming and service delivery for MSM as well as health communication. Following exclusion of ineligible records and removal of duplicates, 84 records were charted and thematically analysed according to scoping review methods. Four themes emerged from the thematic analysis of data; ‘PrEP service aspects, settings and staff’; ‘PrEP prescriber experiences, therapeutic alliance and care planning’; ‘PrEP adherence within formal service structures’; and ‘Multi-disciplinary and innovative PrEP care pathways’. The review highlights the complexities in providing optimal PrEP services for MSM by mapping and illustrating the importance of understanding the informal and formal routes to PrEP use among this HIV risk population; the barriers to uptake; the requirement for the presence of a positive therapeutic alliance between patient and prescriber in supporting patient initiation and adherence to PrEP regimes; and the need for availability in different culturally and ethnically sensitive models of PrEP service delivery according to low to high risk groups within the MSM communities.
Highlights
In 2016, the United Nations General Assembly agreed that a fast-track response was required to end AIDS by 2030 and reduce new HIV infections to fewer than 500,000 annually by 2020 worldwide
The roll out of Pre-exposure prophylaxis (PrEP) along with continued support in testing and rapid access to treatment are the key drivers in the elimination of HIV and it is for this reason that the WHO and UNAIDS have prioritised PrEP implementation for populations at the highest risk of HIV [4, 27, 28]
Strengths centre on the thoroughness of the review approach through extensive searches to locate all forms of information with regard to PrEP service aspects and programming
Summary
In 2016, the United Nations General Assembly agreed that a fast-track response was required to end AIDS by 2030 and reduce new HIV infections to fewer than 500,000 annually by 2020 worldwide. PrEP is an evidence-based biomedical HIV prevention intervention which involves the pre-emptive use of daily (or event-based) ARTs [tenofovir disoproxil fumurate (TDF) and emtricitabine (FTC)] to reduce the risk of HIV acquisition if exposed [14, 15]. Given its successes in efficacy, [21, 22] PrEP is considered as an integral tool in the progressive strengthening of a combined HIV prevention programme among MSM, which includes 100% condom use, [23] voluntary HIV testing and counselling services, [24, 25] and HIV treatment as prevention (TasP) [26]. The roll out of PrEP along with continued support in testing and rapid access to treatment are the key drivers in the elimination of HIV and it is for this reason that the WHO and UNAIDS have prioritised PrEP implementation for populations at the highest risk of HIV [4, 27, 28]
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