Demand creation and retention strategies for oral pre-exposure prophylaxis for HIV prevention among men who have sex with men and transgender women: a systematic review and meta-analysis

Abstract

Background: Men who have sex with men (MSM) and transgender women (TGW) have a disproportionately higher risk of human immunodeficiency virus (HIV) infection than other groups. Oral HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool and should be offered to those at higher risk. Identifying demand creation strategies (DCS) and retention strategies (RS) to improve PrEP persistence is essential to control the HIV epidemic.

Aim: We aimed to identify the (DCS and RS with higher proportions among MSM and TGW.

Methods: A systematic review and meta-analysis of prospective studies were conducted, with studies retrieved from five databases until November, 2022 following the Cochrane and PRISMA guidelines. The study protocol was registered in PROSPERO (CRD42022323220). The outcomes were DCS and RS for PrEP use among MSM and TGW. Strategies used for users enrolled in the PrEP-recruited (DCS) were classified as face-to-face (peer educator recruitment at social venues, nongovernmental organizations, and parties; direct referrals by health services; friends and/or sexual partners); online (chatbot or peer educator recruitment on social media [e.g., , Instagram or Facebook] or dating/hook-up apps [e.g., Grindr, Tinder, Badoo, and Scruff]); and mixed (face-to-face and online). RS was classified as provider counseling (face-to-face by a health professional; prevention of HIV risk counseling, distribution of condoms, lubricants, and testing for HIV or other sexually transmitted infections); online counseling (text messages, chatbots, telephone calls, social media, and peer educators); and mixed (all previous strategies). Subgroup analyses were conducted for each treatment strategy. Meta-analyses were performed using the R software version 4.2.1.

Results: A total of 1, 129 studies were retrieved from the five databases. After eligibility, 46 studies were included. For MSM, most DCS and RS were online at 91% (95% CI: 0.85-0.97; I²=53%), and 83% (95% CI: 0.80-0.85; I²=17%) respectively. For TGW, mixed DCS and RS were the most frequent at85% (95% CI: 0.60-1.00; I²=91%) and online counseling at 84% (95% CI: 0.64-0.95) compared to other strategies.

Conclusion: Critical issues play. Pivotal role in increasing PrEP awareness among MSM and TGW, minimizing access gaps, and ensuring retention of PrEP services. Offering oral PrEP using online DCS and RS can reach and retain high numbers of MSM and TGW, and reduce HIV incidence in these populations.

Keywords: Demand creation to PrEP access; Men who have sex with men; Prevention of HIV infection; Retention in PrEP services; Transgender women.

Fig. 1

Forest plot of pooled proportions of MSM and TGW enrolled in PrEP DCS (n=09)

Fig. 2

Forest plot of pooled proportions of PrEP DCS among the entire sample (MSM and TGW) (n=10 report and 09 studies because of difference strategies)

Fig. 3

Forest plot of pooled proportions of PrEP DCS among MSM (n=19)

Fig. 4

Forest plot of pooled proportions of PrEP DCS among MSM (n=19)

Fig. 5

Forest plot of pooled proportions of PrEP DCS among TGW (n=04)

Fig. 6

Forest plot of pooled proportions of PrEP DCS among TGW (n=04)

Fig. 7

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among the entire sample (MSM and TGW) (n=10)

Fig. 8

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among the entire sample (MSM and TGW) by retention strategies (n=10)

Fig. 9

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among MSM (n=19)

Fig. 10

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among MSM by demand creation strategies (n=19)

Fig. 11

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among TGW (n=08)

Fig. 12

Forest plot of pooled proportions of retention to pre-exposure prophylaxis (PrEP) service among TGW by DCS (n=08)