Pre-exposure prophylaxis (PrEP) models of delivery in low to middle income countries: a proposed model for an integrated care model

Abstract

As the global pandemic of HIV continues, many low- and middle-income countries also have an increasing burden of non-communicable diseases (NCDs). When used consistently pre-exposure prophylaxis (PrEP) can reduce the risk of HIV acquisition by over 90%. In 2015 the World Health Organization (WHO) expanded their previous recommendation from offering PrEP to MSM to all populations at significant risk of acquiring HIV. The aim of this study was to identify which models for PrEP service delivery have been successful in low-to-middle income countries, their key components, and how better to include NCD screening and treatment cross sectionally with HIV screening, testing, and treatment programs. A revision of current scientific literature and specialized reports was conducted from November through December of 2021 on PubMed and examined articles published between 2019-2021. 326 articles were reviewed from 7 primary searches. Additional articles were found from references cited by reviewed articles and smaller searches related to individual article findings. 97 articles were read in full, 68 of which were selected for informing this review because they directly addressed the research questions. Our findings reveal that PrEP service provision should be guided through: a) Community engagement; b) On-site PrEP services; c) Partner referralsd) Integrated services along with PrEP. PrEP has been delivered through various models depending on target populations, country policies, and established health infrastructure. Predictive models and implementing project have indicated that PrEP delivery is feasible and cost-effective when delivered in different ways. There are numerous barriers to PrEP uptake that should be considered when implementing PrEP delivery, many of which involve deep-seeded cultural beliefs or reflect community relationships rather than simply presenting logistical challenges and awareness gaps. In addition to PrEP integration, research has shown that using HIV healthcare infrastructure is feasible for delivery of NCD screening and care.