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Review
. 2010 Nov;7(4):210-9.
doi: 10.1007/s11904-010-0062-4.

Implementation science of pre-exposure prophylaxis: preparing for public use

Kristen Underhill  1 , Don Operario, Matthew J Mimiaga, Margie R Skeer, Kenneth H Mayer
Affiliations
Review

Implementation science of pre-exposure prophylaxis: preparing for public use

Kristen Underhill et al. Curr HIV/AIDS Rep. 2010 Nov.

Abstract

As efficacy trials of antiretroviral pre-exposure prophylaxis (PrEP) continue, a growing literature has begun anticipating the potential challenges of implementing PrEP for HIV prevention. These efforts coincide with a shift toward combination interventions for preventing HIV, which integrate biomedical, behavioral, and structural components. The optimal implementation of PrEP would exemplify this combination model, incorporating not only PrEP drugs, but also HIV testing, safety screening, behavioral interventions addressing adherence and risk behavior, and long-term monitoring. Efforts to plan for PrEP implementation therefore present an opportunity to advance the science of implementation and delivery in HIV prevention, in order to better address the challenges of scaling up combination approaches. We review the published and unpublished literature on PrEP implementation, organizing themes into five categories: scientific groundwork, regulatory and policy groundwork, stakeholder and infrastructure groundwork, delivery, and long-term monitoring. The lessons from PrEP planning can benefit the scale-up of future combination interventions.

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Conflict of interest statement

Disclosure

No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Implementation processes identified for pre-exposure prophylaxis.
See this image and copyright information in PMC

References

    1. UNAIDS. Global Facts & Figures. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS; 2009. - PubMed
    1. Lagakos SW, Gable AR. Challenges to HIV prevention - seeking effective measures in the absence of a vaccine. N Engl J Med. 2008;358:1543–1545. - PubMed
    1. Padian NS, Buvé A, Balkus J, et al. Biomedical interventions to prevent HIV infection: evidence, challenges, and way forward. Lancet. 2008;372:585–599. - PubMed
    1. Cohen MS, Gay C, Kashuba ADM, et al. Narrative review: antiretroviral therapy to prevent the sexual transmission of HIV-1. Ann Intern Med. 2007;146:591–601. - PubMed

    1. Paxton LA, Hope T, Jaffe HW. Pre-exposure prophylaxis for HIV infection: what if it works? Lancet. 2007;370:89–93. This article outlines possible implications of PrEP trial results, including implementation challenges.

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