Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job?

Schmidt, Heather-Marie A; Schaefer, Robin; Nguyen, Van Thi Thuy; Radebe, Mopo; Sued, Omar; Rodolph, Michelle; Ford, Nathan; Baggaley, Rachel

doi:10.1016/s2352-3018(22)00006-6

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…Most of the identified PrEP services for people who inject drugs required an HIV or sexual health specialist doctor to prescribe PrEP. However, task sharing with nurses in clinics and community settings to lead PrEP services, including prescribing, has the potential to increase PrEP access, uptake and persistence and generate health system efficiencies [ 29 ] and has been implemented in South Africa. Along with appropriate training and support, nurse-led models could be an effective option for providing PrEP for people who inject drugs, including within broader HIV, tuberculosis and STI prevention, diagnosis and treatment services, and in services for HCV infection, particularly where nurses work with civil society organizations providing harm reduction services to people who inject drugs and other key populations and so tend to be familiar with the legal, socio-cultural, political, and health contexts for people who inject drugs.…”

Section: Discussionmentioning

confidence: 99%

Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery

et al. 2023

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Background The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. Methods Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. Results PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. Conclusions This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.

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Section: Discussionmentioning

confidence: 99%

Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery

et al. 2023

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“…Providers, particularly from less well-resourced settings, also expressed concerns about human resource capacity to provide an injection-based intervention that required relatively frequent clinic visits. While task sharing can facilitate the delivery of PrEP services [10], participants in our consultations raised concerns about regulatory restrictions regarding who can administer intramuscular injections, and management of possible side effects or any drug-drug interactions. These issues are related to broader concerns about how the integration of CAB-LA could lead to a remedicalization of PrEP services -requiring more clinic visits and staff who can administer injections -and undermine some bene ts of community-based PrEP services, especially for stigmatized populations.…”

Section: Discussionmentioning

confidence: 99%

“…WHO has published guidance to support differentiated PrEP services [5], using a framework of four building blocks of differentiated service delivery: service location (where), frequency (when), package (what), and provider (who). Examples of service adaptations within those building blocks include community-, pharmacy-, and home-based PrEP delivery ("where") [6,7], multi-month dispensing to reduce follow-up visits ("when") [8], integrated services ("what") [9], and task sharing with various health worker cadres and lay providers ("who") [10]. The use of HIV self-testing (HIVST) has supported many of these differentiated PrEP service delivery models.…”

Section: Introductionmentioning

confidence: 99%

The future of pre-exposure prophylaxis (PrEP) for HIV prevention: Provider perspectives

Henderson

Schmidt

Chitembo

et al. 2023

Preprint

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Background: Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on innovations in service delivery and products to inform World Health Organization (WHO) guidelines and programme implementation. Methods: 150 PrEP providers who participated in a WHO online survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted via video calls. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. Results: 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients’ needs and preferences, maintain services during COVID-19, and ensure access for hard-to-reach populations. Providers welcomed prospects of offering an CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Conclusions: Providers’ views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.

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“…Paradoxically, although the COVID-19 pandemic restricted sex workers’ access to clinical services in many settings, it also led to loosening of prescribing and distribution restrictions, accelerating scale-up of DSD approaches to PrEP [54 ▪ ]. Other distribution-related developments include combining PrEP with self-test kits, task-shifting to nurses or peer volunteers [60,61 ▪▪ ]. These approaches have not been designed specifically for sex workers, but would meet many of their needs that relate to documented barriers to their regular attendance at set appointment times that may not fit with their travel and work schedules, or necessitate long waiting times, frequently in locations where they fear being recognized as sex workers [62–66].…”

Section: New Developments and Directionsmentioning

confidence: 99%

HIV prevention in individuals engaged in sex work

Busza

Matambanadzo

Phiri³

et al. 2022

Current Opinion in Infectious Diseases

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Purpose of reviewPeople who sell sex remain at disproportionate risk of acquiring HIV and should be prioritized for evidencebased HIV prevention programmes delivered at sufficient scale and intensity for effectiveness. Although new biomedical tools are becoming available, many basic lessons learned early in the HIV pandemic remain salient today and need renewed attention. Recent findingsNew preexposure prophylaxis formulations, distribution systems, and delivery mechanisms are being successfully trialled and implemented, adding to well established prevention tools such as male and female condoms and lubricants. The importance of social support networks and community ownership of programmes has been consistently reaffirmed. Serious challenges remain in optimizing HIV prevention for sex workers, including providing services at the scale and intensity necessary for population level impact, addressing culturally sensitive issues of gender identity and sexual orientation, and protecting adolescents and young people who may sell sex. Pervasive social stigma, often reinforced by criminalization and police harassment, further constrain sex workers access to available services and prevention tools. SummaryMeaningful community engagement and addressing the multiple social determinants of vulnerability at individual, community, and structural levels remain at the core of preventing HIV among people involved in selling sex.

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Scaling up access to HIV pre-exposure prophylaxis (PrEP): should nurses do the job?

Cited by 19 publications

References 26 publications

Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery

Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery

The future of pre-exposure prophylaxis (PrEP) for HIV prevention: Provider perspectives

HIV prevention in individuals engaged in sex work

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