The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery

Abstract

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 differentiated PrEP service delivery and new PrEP products to inform World Health Organization (WHO) guidelines and programme implementation. 150 PrEP providers who participated in a WHO 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 virtually. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. 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 priority populations that may face access challenges. Providers welcomed prospects of offering 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 cisgender women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. 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.

COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics, a global consultation

“…The findings reported are from a global consultation which was initiated as part of the development of WHO guidelines on COVID-19 self-testing. As such, it was carried out in accordance with the WHO Handbook for Guideline Development https://apps.who.int/iris/handle/10665/145714 and aligns with standards used in previous published WHO consultations [ 12 ]. The development of all WHO guidelines is overseen by the WHO Guideline Review Committee.…”

Improving preparedness for introducing and scaling up long-acting HIV pre-exposure prophylaxis in Asia

“…There are major concerns about clinical and organisational capacity to deliver injection-based services within existing resources and infrastructure. 10,14,18 Currently, CAB-LA requires injections every 8 weeks, compared with the recommended 12-weekly visits for oral PrEP users; injections must be delivered by a trained healthcare worker during the visit, which has the potential to add more time to visits and restrict the capacity of non-clinicians to provide the service; and follow-up visits must be monitored more closely than for oral PrEP, and may require active follow up, given the strict 2-week window for on-time injections. Some of these concerns may be alleviated over time.…”

The use of oral HIV pre-exposure prophylaxis among people who inject drugs: barriers, and recommendations

“…Furthermore, fewer HCWs may be required compared to when the services are offered separately ( 8 ). In addition, providing oral PrEP in a range of routine settings may help reduce the stigma associated with specialized clinics and HIV services ( 26 ). However, the HCWs may need to be trained on the provision of oral PrEP services since some may not be familiar with the services.…”

“…Differentiated service delivery models can also help reduce the workload of HCWs at healthcare facilities, especially in low-to-middle-income countries that have understaffed healthcare facilities ( 28 ). We also recommend the use of long-acting products for PrEP such as long-acting injectable Cabotegravir and Dapivirine vaginal ring as they may help solve the problems of forgetfulness and having to return to the healthcare facilities frequently ( 26 ).…”