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Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions

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Abstract

Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States. To date, the literature has focused on identifying determinants of PrEP use, with a lesser focus on developing and testing change methods to improve PrEP implementation. Moreover, the change methods available for improving the uptake and sustained use of PrEP have not been systematically categorized. To summarize the state of the literature, we conducted a systematic review of the implementation strategies used to improve PrEP implementation among delivery systems and providers, as well as the adjunctive interventions used to improve the uptake and persistent adherence to PrEP among patients. Between November 2020 and January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer reviewed articles. We identified 44 change methods (18 implementation strategies and 26 adjunctive interventions) across a variety of clinical and community-based service settings. We coded implementation strategies and adjunctive interventions in accordance with established taxonomies and reporting guidelines. Most studies focused on improving patient adherence to PrEP and most conducted pilot trials. Just over one-third of included studies demonstrated a positive effect on outcomes. In order to end the human immunodeficiency virus (HIV) epidemic in the U.S., future, large scale HIV prevention research is needed that develops and evaluates implementation strategies and adjunctive interventions for target populations disproportionately affected by HIV.

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Data Availability

We included supplemental files of our codebook, which includes operational definitions of codes. The systematic review dashboard, which a portion of our studies were drawn from is freely available at https://hivimpsci.northwestern.edu/dashboard/. Additional data is available from the authors upon request.

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Funding

This work was supported by a supplement grant to the Third Coast Center for AIDS Research, an NIH-funded center (P30 AI117943; PI: D’Aquila; Supplement PIs: Mustanski & Benbow). J.D. Smith was supported by the CIRCL-Chicago Implementation Research Center (UG3 HL154297) and the Utah Clinical and Translational Science Institute (UM1 TR004409). James Merle was supported by a training grant from the National Library of Medicine (T15LM007124; PI: Eilbeck). JPZ and az’s time was supported by a training grant from the National Institute of Mental Health (T32MH130325; PI: Newcomb). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA

    James L. Merle & Justin D. Smith

  2. Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA

    Nanette Benbow, Dennis H. Li & Brian Mustanski

  3. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA

    Nanette Benbow, Dennis H. Li, Juan P. Zapata, Artur Queiroz, Alithia Zamantakis & Brian Mustanski

  4. Brown School, Washington University in St. Louis, St. Louis, MO, USA

    Virginia McKay

  5. Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Brennan Keiser

  6. Public Health and Epidemiology Unit, Westat, Rockville, MD, USA

    Juan A. Villamar

  7. Department of Infectious Diseases, Northwestern University, Seattle, WA, USA

    Brian Mustanski

  8. Medical Social Sciences Department, Northwestern University, Seattle, WA, USA

    Brian Mustanski

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Contributions

BM, DL, NB, and JDS conceived of the paper. DL and BK performed the literature search. JLM, DL, BK, JPZ, AQ, AZ, VM, and JV conducted the screening for inclusion and contributed to the coding. JLM performed the data analysis and synthesis. All authors drafted and/or critically revised the work.

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Correspondence to James L. Merle.

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The authors have no relevant financial interests to disclose. Dr. Brian Mustanksi is an associate editor of the journal.

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Merle, J.L., Benbow, N., Li, D.H. et al. Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04331-0

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