Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States

AbstractPurpose of ReviewDespite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system.Recent FindingsTask shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings.Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff.Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, atailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual.SummaryWe highlight recent advances and ev...
Source: Current HIV/AIDS Reports - Category: Infectious Diseases Source Type: research