Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

Area of Science:

• Public Health
• HIV Prevention
• Health Services Research

Background:

• Pre-exposure prophylaxis (PrEP) is a key biomedical intervention for HIV prevention.
• Challenges in PrEP access and implementation contribute to suboptimal uptake in the United States.
• Understanding barriers is crucial for effective PrEP scale-up.

Purpose of the Study:

• To review PrEP implementation from 2007-2017.
• To identify barriers to PrEP access and uptake.
• To identify interventions addressing these barriers.

Main Methods:

• Systematic review of articles published between 2007 and 2017.
• Analysis of 47 selected articles focusing on PrEP implementation.
• Categorization of barriers and interventions across cognitive, healthcare system, and stigma-related domains.

Main Results:

• Cognitive barriers include provider and patient knowledge, attitudes, and beliefs about PrEP.
• The "purview paradox" highlights a disconnect between HIV specialists and primary care physicians regarding PrEP provision.
• Healthcare system barriers involve communication, funding, and access issues.
• Intersectional stigma (PrEP, HIV, transphobia, homophobia) and disparities (gender, race, ethnicity) were identified but rarely addressed by interventions.

Conclusions:

• Multiple barriers impede PrEP access and uptake, including cognitive, systemic, and stigma-related factors.
• Few interventions effectively address the intersectional nature of these barriers.
• Multilevel interventions targeting various socioecological domains are recommended to enhance PrEP implementation and accessibility.