A Review of HIV Pre-exposure Prophylaxis Streamlining Strategies
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THE SCIENCE OF PREVENTION (JD STEKLER AND JM BAETEN, SECTION EDITORS)
A Review of HIV Pre-exposure Prophylaxis Streamlining Strategies Aaron J. Siegler 1
&
Kevin Steehler 1,2 & Jessica M. Sales 1 & Douglas S. Krakower 3
# The Author(s) 2020
Abstract Purpose of Review Standard care for HIV pre-exposure prophylaxis (PrEP) in the USA creates substantial burdens for patients, clinicians, and the healthcare system; to optimize uptake, there is a need for innovative strategies to streamline its provision. Recent Findings Our review, structured by the expanded chronic care model, identified eleven promising strategies to streamline PrEP care. Approaches ranged widely in mechanism of action. Using text messages to support care was the only strategy with clinical trial evidence supporting its use. Other modalities such as patient navigation, telemedicine PrEP models, alternate dosing availability, same-day prescription, and provider training have promising pilot or associational data and seem likely to lower barriers to entering into or remaining in care. Many of the strategies have established success in related domains such as HIV care, meriting consideration in evaluating their use for PrEP. Summary Making PrEP care less burdensome will be an important part of bringing it to scale. Text message interventions have proven efficacy and merit broad adoption. Encouraging preliminary evidence for other strategies indicates the importance of building a stronger evidence base to clarify the effect of each strategy. Ongoing development of an evidence base should not delay the use of these promising strategies; instead, it calls for careful consideration for how each program may best match its environment to facilitate PrEP prescribing and use. Keywords Chronic care model . mHealth . Telemedicine . PrEP
Introduction The first major trial of HIV pre-exposure prophylaxis (PrEP), iPrEX, demonstrated the high efficacy of PrEP in 2010 [1]. By 2018, an estimated 380,000 persons had initiated PrEP globally, with the majority (225,000) residing in the USA [2]. In New South Wales, Australia, an encouraging PrEP implementation project initiated 9700 PrEP users across 21 sites. A populationlevel decline in new HIV diagnoses was observed after the first phase of the project, with 295 new diagnoses decreasing to 221 new diagnoses, a 25% decline. Similarly, in San Francisco, as This article is part of the Topical Collection on The Science of Prevention * Aaron J. Siegler [email protected] 1
Department of Behavioral Sciences and Health Education, Emory University, Rollins School of Public Health, Atlanta, GA, USA
2
Emory University, School of Medicine, Atlanta, GA 30322, USA
3
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, The Fenway Institute, Fenway Health, Department of Population Medicine, Harvard Medical School, Boston, MA, USA
PrEP and other “getting to zero” efforts scaled up rapidly, new HIV diagnoses were observed to decline substantially [3]. To observe similar population-level gains elsewhere, it wi
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