Expanding Knowledge About Implementation of Pre-exposure Prophylaxis (PrEP): A Methodological Review

Abstract

Methodological limitations in PrEP implementation studies may explain why PrEP implementation is lagging. This methodological review provides a description and critique of the methods used to identify barriers to PrEP implementation in the United States (2007-18). For each selected article, we provide: (1) research questions; (2) measures; (3) design; (4) sample (size and type); and (5) theoretical orientation. Among 79 articles which identified knowledge, attitudes, and behavioral and social/structural barriers to PrEP implementation, 51 (65%) were quantitative; 25 (32%) qualitative; and 3 (4%) were mixedmethods; overall, just one-half described a conceptual approach. About two-thirds of articles were conducted with patients and one-third with healthcare providers. Our review reveals a paucity of longitudinal, mixed-methods, and ethnographic/ observational research and guiding theoretical frameworks; thus, the applicability of results are limited. We recommend that interventions aimed at PrEP implementation address barriers situated at multiple ecological domains, and thus improve PrEP access, uptake, and adherence.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

“…However, additional research is needed to answer questions more fully about how PrEP has changed sex for women in the U.S. and abroad. Currently, the extant literature is limited largely to assessments of knowledge and attitudes about PrEP, as well as implementation barriers that hinder uptake (Bradley et al, 2019;Celum et al, 2015;Goparaju et al, 2017;Pinto et al, 2019). Data on how PrEP has changed women's sexual satisfaction, relationships, partner selection, sexual anxiety, sexual self-esteem, sexual communication, and community norms are limited.…”

Student Education About Pre-exposure Prophylaxis (PrEP) Varies Between Regions of the United States

“…3 Our results demonstrate TWSM are largely excluded from PrEP education, which may represent deficiency of content on transgender health in health professions curriculum and may be a prohibiting factor in efforts to decrease HIV in this community. [81][82][83] Recent work has identified a substantial role of stigma in PrEP access for TWSM, particularly TWSM of color. 84 Avoiding education on these trends and disparities may perpetuate stigma.…”

PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia

“…Consisting of some of the same active regiments used in antiretroviral (ARV) therapy (ART), HIV pre-exposure prophylaxis (PrEP) has been shown to protect against HIV infection in MSM and TGW [ 6 , 7 ], provided that users are adherent [ 8 , 9 , 10 , 11 , 12 ]. Individuals need to take PrEP during periods of high risk of exposure to HIV, a concept that has been termed “prevention-effective adherence” [ 12 ].…”

“…Given the current HIV epidemic among MSM/waria in Indonesia [ 1 , 2 , 3 ], the inclusion of PrEP within Indonesia’s HIV response [ 24 , 25 ] should be prioritized. Regardless of the lack of regulatory, approval, or national guidelines for PrEP, comprehensive and focused studies and preparation to support PrEP best practice and legal distribution should be established so that enablers and barriers of successful PrEP implementation can be identified and addressed [ 9 , 10 , 26 ]. Data on how the potential users would respond towards PrEP are needed before the official introduction of PrEP in Indonesia.…”