Delivering HIV pre-exposure prophylaxis (PrEP) care online: A scoping review

Abstract

ObjectivesHIV pre-exposure prophylaxis (PrEP), in which people take HIV medication to prevent HIV acquisition, is a highly effective method of HIV prevention; however, global implementation of PrEP is patchy. PrEP provision will need to be upscaled significantly to achieve UNAIDS/WHO goals of elimination of HIV transmission. Online provision of PrEP care could enhance access to, and delivery of, care at scale. We explored the extent to which PrEP care has been delivered online to inform the development of a novel online PrEP clinic.DesignScoping review.Data sourcesEmbase, MEDLINE, Web of Science, CINAHL, PsycINFO, ASSIA, PUBMED, Open Grey, and EThOS databases.Eligibility criteriaEnglish language articles describing a service that delivered one or more element of PrEP-related care online, published from 2009 onwards.Data extraction and synthesisData were extracted using matrices and synthesised using summary statistics and thematic analysis. The Mixed Methods Appraisal Tool was used to assess study quality.ResultsFifty-nine articles were included: eight randomised controlled trials, 12 non-randomised quantitative studies, 30 descriptive quantitative studies, 14 qualitative studies, and four reviews of online content. Seven studies detailed comprehensive PrEP care pathways that used a combination of online, face-to-face and telephone based care. Of the remaining studies, the majority focused on HIV testing outside a PrEP context. Care tended to be delivered via websites (n=41), video chat, and smartphone apps (both n=10). The acceptability and feasibility of delivering elements of care online was high.ConclusionsOnline PrEP care appears feasible and acceptable, offering convenience and a means to overcome some of the reported barriers to face-to-face care. Services tended to focus on a single element of PrEP-related care or use a combination of online, face-to-face and phone-based care. Additional formative work is needed to inform the development of complete online PrEP care pathways.Strengths and limitations of this studyThis scoping review provides a comprehensive, critical overview of existing literature related to online provision of HIV pre-exposure prophylaxis (PrEP)-related care.We developed a comprehensive definition of PrEP care which took into consideration all essential elements of care required for safe and appropriate PrEP prescribing.Established guidelines for conducting and reporting scoping reviews were followed throughout.We conducted an exhaustive search of nine databases.The heterogeneity in design and aim of the included studies limited our ability to synthesise findings.

Protocol for a scoping review of literature on digital sexual, reproductive, and gender health care for LGBTQI+ youth

“…1) information delivered online on websites (e.g., World Health Organisation [WHO], 2022; Magee et al, 2012) or through online education programmes (e.g., Mustanski et al, 2015;Lacombe-Duncan et al, 2021); 2) advice and support online which may involve use of telecommunication such as video calls, live chats, email, or text services with charity or community-based organisation staff or peers (e.g., Radix et al, 2022;Skeen & Cain, 2022); and 3) clinical care provided online, such as STI/HIV self-sampling kits and test results (e.g., Bauermeister et al, 2015;Estcourt et al, 2017;Hottes et al, 2012;Ling et al, 2010;Brugha et al, 2011);PrEP (ePrEP;Kincaid et al, 2021); partner notification (PN) and testing options (e.g., Golden et al, 2022;Flowers et al, 2021;Mimiaga et al, 2008); and consultations (eConsult) and telemedicine (e.g., Sequeira et al, 2021;Lucas et al, 2023).…”

Opening the digital doorway to sexual healthcare: Recommendations from a Behaviour Change Wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations

“…Such healthcare includes online postal self-sampling (OPSS) for sexually transmitted infection (STI) and blood borne virus (BBV) testing (e.g., [5][6][7][8]. More complex online clinical care pathways are also in development, such as the eSexual Health Clinic for accessing STI test results and treatment (9) and ePrEP for accessing HIV prevention medication, pre-exposure prophylaxis (PrEP) (10). For many people, the initial steps to accessing sexual healthcare, both online and traditional (i.e., in-person/phone), are seeking sexual health information and support online (11)(12)(13).…”

HIV PrEP: raise awareness in all groups who could benefit and provide for both on and offline access

“…Digital services are already integral parts of care pathways for people accessing pre-exposure prophylaxis (PrEP) in many parts of the UK and considerable research is underway 1. Many services offered some elements of PrEP care online before 2020, which enabled rapid transition to hybrid online and telephone based PrEP care during the pandemic 23. Research presented at a recent national conference showed the acceptability of online PrEP 456…”