HIV Pre-Exposure Prophylaxis Care Continuum in Outpatient Settings: A Systematic Review and Meta-Analysis

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• HIV Prevention

Background:

• Pre-exposure prophylaxis (PrEP) is a key biomedical intervention for HIV prevention.
• Understanding engagement in the PrEP care continuum is crucial for optimizing its effectiveness.
• Gaps in the PrEP care continuum limit its reach among at-risk populations.

Purpose of the Study:

• To systematically review and meta-analyze engagement in the oral PrEP care continuum among HIV-negative individuals at risk for HIV in U.S. outpatient settings.
• To identify key gaps and areas of low effectiveness within the PrEP care continuum.
• To inform the development of targeted interventions to improve PrEP uptake and adherence.

Main Methods:

• Systematic review and meta-analysis of U.S. studies published from January 2012 to August 2022.
• Included studies reported at least two steps of the PrEP care continuum, from identification to initiation.
• Random-effects meta-analyses and subgroup analyses were performed on pooled proportions.

Main Results:

• 34 studies comprising 71,162 individuals were included.
• Engagement progressively declined across the continuum: 66% had HIV risk awareness, 34% initiated PrEP.
• Lower initiation rates were observed in emergency departments and among individuals with sexually transmitted infections.

Conclusions:

• Significant declines in engagement exist across the PrEP care continuum, highlighting critical intervention gaps.
• Comprehensive strategies are needed to enhance HIV risk perception and capitalize on healthcare touchpoints.
• Targeted efforts in emergency departments and STI clinics are essential for improving PrEP initiation.