Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations — Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine

Abstract

Purpose of Review A gap exists between PrEP interest and PrEP uptake in key populations (KP) for HIV prevention that may be ascribed to PrEP delivery services not being acceptable. This review summarizes novel platforms for HIV prevention outside of the traditional health facilities environment. Recent Findings Mobile health clinics provide highly acceptable integrated, KP-focused services at convenient locations with the potential of high PrEP uptake. Telemedicine and health apps decongest health systems and allow for personal agency and informed decision-making on personal health. Pharmacy-led PrEP delivery provides de-medicalized, confidential PrEP services at extended hours in community locations, from trusted medical professionals. Peer-supported delivery encourages continued PrEP use. Summary Community-based, differentiated and de-medicalized PrEP delivery can address uptake and continued use barriers in key populations. Future research should assess scalability, cost-effectiveness and sustainability of these PrEP delivery platforms, as well as focus on ways to simplify PrEP provision.

Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness

“…Finally, PrEP education delivered by peers (i.e., via “word of mouth”) was motivational for participants, suggesting that research should further explore the potential for peer-delivered PrEP education and referrals throughout patients’ social networks. 55 – 57 …”

Telehealth Interventions for HIV in Low- and Middle-Income Countries

“…Differentiated models of PrEP service delivery such as key population (KP)-led PrEP services, mobile health clinics and pharmacy-led PrEP aim to ensure that PrEP is accessible to all who could benefit including KPs and other vulnerable groups [ 28 , 29 ]. Telehealth and mHealth approaches to generating demand and delivering PrEP are increasingly being implemented and tested to support these efforts and show promise in overcoming barriers to PrEP uptake [ 5 •].…”

“…For people living with HIV (PLHIV) in resource-limited settings, the high frequency of clinic appointments required in traditional HIV service delivery models presents a barrier to ART scale-up and maintenance [ 28 , 40 ]. Person-centered differentiated service delivery (DSD) models including multi-month dispensing of ART, community-based medication pickup points, out-of-facility care, and task shifting to KP lay providers [ 41 – 43 ], aim to improve treatment access and reduce unnecessary burdens on the health system [ 44 ].…”

Pre-exposure prophylaxis for HIV: effective and underused

“…Successful examples include nurseled community or sexual health clinics and pharmacistled delivery and mobile dropin clinics that offer lowbarrier PrEP. 4,41,43 Technology can also be used to improve access to PrEP in lessresourced settings or to increase convenience of appoint ments via telehealth or virtual care to connect with providers in more wellresourced areas. 43 Communitybased peersupport programs can increase engagement based on trust and culturally informed perspectives for marginalized communities.…”

“…4,41,43 Technology can also be used to improve access to PrEP in lessresourced settings or to increase convenience of appoint ments via telehealth or virtual care to connect with providers in more wellresourced areas. 43 Communitybased peersupport programs can increase engagement based on trust and culturally informed perspectives for marginalized communities. 37,43 Public health leaders also have a responsibility to raise awareness about PrEP as a safe and effective preventive health strategy for many populations.…”