Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review

Abstract

Background: Pre-exposure prophylaxis (PrEP) is an emerging biomedical prevention intervention. Documenting PrEP service delivery models (SDMs) that promote linkage to and continuation of PrEP will inform guidelines and maximise roll-out.

Objectives: To synthesise and appraise the effectiveness and feasibility of PrEP SDMs designed to promote linkage to PrEP care among adolescent girls and young women (AGYW) and men in sub-Saharan Africa (SSA).

Eligibility criteria: Primary quantitative and qualitative studies published in English and conducted in SSA were included. No restrictions on the date of publication were applied.

Sources of evidence: Methodology outlined in the Joanna Briggs Institute reviewers' manual was followed. PubMed, Cochrane library, Scopus, Web of Science and online-conference abstract archives were searched.

Charting methods: Data on article, population, intervention characteristics and key outcomes was charted in REDCap.

Results and conclusion: Of the 1204 identified records, 37 (met the inclusion criteria. Health facility-based integrated models of PrEP delivery with family planning, maternal and child health or sexual and reproductive services to AGYW resulted in PrEP initiation of 16%-90%. Community-based drop-in centres (66%) was the preferred PrEP outlet for AGYW compared with public clinics (25%) and private clinics (9%). Most men preferred community-based delivery models. Among individuals who initiated PrEP, 50% were men, 62% were <35 years old and 97% were tested at health fairs compared with home testing. Integrated antiretroviral therapy (ART)-PrEP delivery was favoured among serodiscordant couples with 82.9% of couples using PrEP or ART with no HIV seroconversions. PrEP initiation within healthcare facilities was increased by perceived client-friendly services and non-judgemental healthcare workers. Barriers to PrEP initiation included distance to travel to and time spent at health facilities and perceived community stigma. PrEP SDMs for AGYW and men need to be tailored to the needs and preferences for each group. Programme implementers should promote community-based SDMs to increase PrEP initiation among AGYW and men.

Keywords: HIV & AIDS; public health.

Figure 1

Oral PrEP cascade: Adapted from Dunbar et al (2018). Following an HIV-negative diagnosis (step 1), an individual is assessed for risk of HIV (step 2). An individual at substantial risk of HIV acquisition or who requests PrEP is assessed for eligibility for PrEP (step 3). After documenting eligibility for PrEP use, several baseline clinical investigations are conducted (step 4 PrEP is initiated (step 5) on the same-day as HIV testing. The recommended regimen is tenofovir (TDF)/emtricitabine (FTC) one tablet by mouth daily. PrEP continuation visits (step 6) include: month 1, every 3 months. PrEP is discontinued (step 7) if the individual tests HIV positive, develops renal disease, is non-adherent, does not want or need PrEP, no longer meets eligibility criteria or if there are safety concerns. PrEP, pre-exposure prophylaxis.

Figure 2

PRISMA flow diagram adapted from: Moher et al. PrEP, pre-exposure prophylaxis; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.