Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review.
Marcela Antonini, Ingred Evangelista da Silva, Henrique Ciabotti Elias and 3 others
PMID 37377313WHAT IT FOUND
People who stopped taking PrEP cited stigma, cost, and health system failures more often than forgetfulness or side effects.
Nurses should assess these external barriers early, as they drive unintentional discontinuation.
Key findings
01Stigma related to HIV and promiscuity, along with fear of being identified as HIV-positive, were prominent social barriers to PrEP continuity.
02Structural issues, including cost, lack of insurance, long wait times, and health professional resistance or lack of knowledge, significantly hindered PrEP access and adherence.
03Individual barriers like side effects and forgetfulness were present, but external social and structural challenges impacted continuity more heavily, often making discontinuation unintentional.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were conducted in the USA and Africa, limiting generalizability to other regions like Latin America or Europe. The review focused primarily on men who have sex with men (MSM) and transgender populations, with fewer studies on cisgender women or other at-risk groups. Search strategy was limited to four databases, which may have missed relevant studies. The review excluded studies with mixed participants (users and non-users), which may have limited the scope of available data.
Declared interests
The paper does not state any specific conflicts of interest or funding sources.
The easy way to misread this
Do not assume that side effects or forgetfulness are the primary reasons patients stop PrEP. The review found that social stigma and structural barriers like cost and health system navigation were more impactful on discontinuation, meaning clinical focus should extend beyond medication management to psychosocial and logistical support.