Scaling-up PrEP Delivery in Sub-Saharan Africa: What Can We Learn from the Scale-up of ART?

O’Malley, Gabrielle; Barnabee, Gena; Mugwanya, Kenneth

doi:10.1007/s11904-019-00437-6

Cited by 66 publications

(65 citation statements)

References 81 publications

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“…Similarities between PrEP and ART could, however, also lead to confusion: PrEP use hinges on perceived risk situations and preferences for a particular prevention tool. Stopping and starting pill-taking is to be expected with PrEP, and some scholars speak about PrEP as a "prevention-effective" strategy [53,58], i.e. being used as long as the risk exists; ART, by contrast, is a life-long treatment strategy [3].…”

Section: Discussionmentioning

confidence: 99%

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

et al. 2020

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Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men's motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner's HIV-status. Men's self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men's sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men's uptake of PrEP will need to be addressed, in terms of more malefriendly services as well as trialing community-based PrEP education and service delivery.

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Section: Discussionmentioning

confidence: 99%

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

et al. 2020

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“…As a result, regulatory approvals for PrEP have moved forward at a rapid pace without sufficient consideration of their appropriateness for youth under the age of legal majority . Although there is practical advice on how to implement PrEP at the country level, laws restricting adolescents’ ability to independently consent to SRH services may deter adolescents from seeking PrEP and prevent providers from offering confidential SRH services to their adolescent patients . While PrEP represents a promising biomedical intervention with great potential to help decrease worldwide HIV incidence among adolescents, its full effectiveness will only be realized if it is accessible .…”

Section: Introductionmentioning

confidence: 99%

Getting youth PrEPared: adolescent consent laws and implications for the availability of PrEP among youth in countries outside of the United States

et al. 2019

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Introduction Youth under the age of 25 are at high risk for HIV infection. While pre‐exposure prophylaxis (PrEP) has the potential to curb new infections within this population, it is unclear how country‐specific laws and policies that govern youth access to sexual and reproductive health (SRH) services impact access to PrEP. The purpose of this review was to analyse laws and policies concerning PrEP implementation and SRH services available to youth in countries with a high HIV incidence. To the best of our knowledge this is the first systematic assessment of country‐level policies that impact the availability of PrEP to adolescent populations. Methods We conducted a review of national policies published on or before 12 June 2018 that could impact adolescents’ access to PrEP, SRH services and ability to consent to medical intervention. Countries were included if: (1) there was a high incidence of HIV; (2) they had active PrEP trials or PrEP was available for distribution; (3) information regarding PrEP guidelines were publicly available. We also included a selected number of countries with lower adolescent HIV incidence. Internet and legal database searches were used to identify policies relevant to adolescent PrEP (e.g. age of consent to HIV testing). Results and Discussion Fifteen countries were selected for inclusion in this review. Countries varied considerably in their respective laws and policies governing adolescents’ access to PrEP, HIV testing and SRH services. Six countries had specific polices around the provision of PrEP to youth under the age of 18. Five countries required people to be 18 years or older to access HIV testing, and six countries had specific laws addressing adolescent consent for‐ and access to‐ contraceptives. Conclusions Adolescents’ access to PrEP without parental consent remains limited or uncertain in many countries where this biomedical intervention is needed. Observational and qualitative studies are needed to determine if and how adolescent consent laws are followed in relation to adolescent PrEP provisions. Intensified efforts to amend laws that limit adolescent access to PrEP and restrict the establishment of national guidelines supporting adolescent PrEP are also needed to address the epidemic in this group.

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“…PrEP provision was subsequently scaled up in the same settings where initial experience with PrEP delivery was built. One of the lessons learned from the scale-up of centralised ART delivery models for PLWH, is that these settings may become overcrowded as demand grows [62]. Additionally, geographic accessibility issues and tailoring care to different subpopulations are other challenges identi ed in centralised clinical settings for ART delivery [62].…”

Section: Discussionmentioning

confidence: 99%

“…One of the lessons learned from the scale-up of centralised ART delivery models for PLWH, is that these settings may become overcrowded as demand grows [62]. Additionally, geographic accessibility issues and tailoring care to different subpopulations are other challenges identi ed in centralised clinical settings for ART delivery [62]. PrEP candidates, who usually are healthy, might even be less motivated than PLWH to travel long distances to health facilities or sit through long waiting periods to access care.…”

Section: Discussionmentioning

confidence: 99%

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

Vanhamel

Rotsaert

Reyniers

et al. 2020

Preprint

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Background: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods: We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings.Conclusions: A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.

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Scaling-up PrEP Delivery in Sub-Saharan Africa: What Can We Learn from the Scale-up of ART?

Cited by 66 publications

References 81 publications

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

Getting youth PrEPared: adolescent consent laws and implications for the availability of PrEP among youth in countries outside of the United States

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

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