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      Examining the Use of HIV Self-Testing to Support PrEP Delivery: a Systematic Literature Review

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          Abstract

          Purpose of Review

          HIV self-testing (HIVST) has the potential to expand access to and uptake of HIV pre-exposure prophylaxis (PrEP) delivery. We conducted a systematic literature review to understand the evidence on HIVST use for PrEP delivery.

          Recent Findings

          After screening 1055 records, we included eight: three randomized trials and five values and preferences studies. None measured PrEP initiation. Most studies occurred in Sub-Saharan Africa (7/8) and included different populations. One trial found that HIVST use between quarterly clinic visits as part of an adherence package with biofeedback slightly increased adherence; the other two trials found that HIVST use between or in lieu of quarterly clinic visits had no significant or non-inferior effects on adherence. HIVST to support PrEP delivery was acceptable, feasible, and preferred.

          Summary

          HIVST use for PrEP continuation largely resulted in similar outcomes to standard-of-care delivery and was perceived acceptable and feasible. Further research is needed to optimize HIVST use within PrEP programming.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11904-022-00617-x.

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          Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas

          Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2021)
          Article 0 comments Cited 182 times – based on 0 reviews     Review now
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            Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

            Kenneth H Mayer, Allison George Agwu, David J Malebranche (2020)
            Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
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              HIV pre‐exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery

              Connie L Celum, Sinead Delany-Moretlwe, Jared Baeten … (2019)
              Abstract Introduction Adolescent girls and young women (AGYW) in Africa have high HIV incidence despite scale‐up of HIV testing and HIV treatment. Placebo‐controlled trials of tenofovir‐based pre‐exposure prophylaxi (PrEP) in diverse populations demonstrated that PrEP works with close to 100% effectiveness if taken with high, but not perfect, adherence. Divergent efficacy estimates among African AGYW led to demonstration and implementation projects to better understand motivations for HIV prevention, uptake, adherence and persistence to PrEP. To inform PrEP programmes, the design and initial findings from PrEP demonstration projects for AGYW are reviewed. Discussion Early lessons from PrEP implementation projects among young African women include: (1) awareness and demand creation with positive messaging about the benefits of PrEP are critical to motivate AGYW to consider this novel prevention technology and to foster awareness among peers, partners, parents and guardians to support AGYW's effective PrEP use; (2) PrEP initiation is high in projects that are integrating PrEP into youth‐friendly clinics, family planning clinics and mobile clinics; (3) young African women at risk are initiating PrEP, based on behavioural characteristics, history of intimate partner violence, depression and 30% prevalence of chlamydia and/or gonorrhoea; (4) provision of youth‐friendly PrEP delivery programmes that integrate reproductive health services, including contraception and the diagnosis and treatment of sexually transmitted infections, increase health impact; (5) messages that emphasize the necessity for high adherence while at potential risk of HIV exposure and support strategies that addresses AGYW's adherence challenges are essential; and, (6) a substantial proportion of AGYW do not persist with PrEP, and strategies are needed to help AGYW assess their ongoing need, motivation and challenges with persisting with PrEP. Conclusions PrEP is feasible to implement in integrated reproductive health service delivery models to reach African AGYW. While PrEP demonstration projects indicate that women with behavioural risks and high rates of sexually transmitted diseases are initiating PrEP; effective strategies to support AGYW's adherence and persistence with PrEP are needed. Lessons learned from oral PrEP delivery, a novel first generation HIV prevention product, are relevant to longer‐acting and less adherence‐dependent strategies which are currently in clinical trials.
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                Author and article information

                Contributors
                Katrina F. Ortblad: kortblad@fredhutch.org
                Journal
                Journal ID (nlm-ta): Curr HIV/AIDS Rep
                Journal ID (iso-abbrev): Curr HIV/AIDS Rep
                Title: Current HIV/AIDS Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1548-3568
                ISSN (Electronic): 1548-3576
                Publication date (Electronic): 29 July 2022
                Publication date PMC-release: 29 July 2022
                Pages: 1-15
                Affiliations
                [1 ]GRID grid.10604.33, ISNI 0000 0001 2019 0495, Department of Public and Global Health, , University of Nairobi, ; Nairobi, Kenya
                [2 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Pharmacy, , University of Washington, ; Seattle, WA 98195 USA
                [3 ]GRID grid.270240.3, ISNI 0000 0001 2180 1622, Public Health Sciences Division, Fred Hutchinson Cancer Center, ; 1100 Fairview Ave N, Seattle, WA 98109 USA
                [4 ]GRID grid.3575.4, ISNI 0000000121633745, Global HIV, Hepatitis and STI Programmes, World Health Organization, ; Geneva, Switzerland
                [5 ]GRID grid.411943.a, ISNI 0000 0000 9146 7108, Department of Community Health, , Jomo Kenyatta University of Agriculture and Technology, ; Nairobi, Kenya
                [6 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Global Health, , University of Washington, ; Seattle, WA 98105 USA
                Article
                Publisher ID: 617
                DOI: 10.1007/s11904-022-00617-x
                PMC ID: 9334974
                PubMed ID: 35904695
                SO-VID: 729ae292-9945-46ed-9d74-9cd31e6346bc
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date accepted : 12 July 2022
                Categories
                Subject: The Science of Prevention (R Heffron and K Ngure, Section Editors)

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: systematic literature review,hiv self-testing,prep delivery,hiv prevention,implementation science,sub-saharan africa
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: systematic literature review, hiv self-testing, prep delivery, hiv prevention, implementation science, sub-saharan africa

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