Scaling up pre-exposure prophylaxis: A global analysis of processes and challenges regarding the implementation of the pre-exposure prophylaxis guidelines.
Junior M Ntimani, Andile G Mokoena-de Beer, Deliwe R Phetlhu
PMID 42084178WHAT IT FOUND
Task-shifting PrEP delivery to nurses, lay counsellors and pharmacy workers was reported to improve service availability, but training gaps, stigma, partner opposition, stockouts and paperwork limited access.
Same-day initiation and community engagement were reported facilitators.
Key findings
01Task-shifting PrEP delivery to nurses, lay counsellors and pharmacy workers was reported to improve service availability and address bottlenecks.
02Stigma and male-partner opposition were reported barriers to PrEP uptake and continuation.
03Same-day initiation, flexible eligibility and community engagement were reported ways to improve PrEP access.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only nine qualitative studies were included, and two did not specify participant numbers. The review excluded grey literature and did not carry out quantitative quality appraisal. Four included studies were from Kenya. Several studies reported only provider views, so client experiences may be missing. The themes were shaped by specific frameworks in some studies, which may have limited additional themes. The included studies were conducted in diverse health systems, so findings may not apply everywhere.
Declared interests
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
The easy way to misread this
Do not read this review as evidence that PrEP, task-shifting or simplified initiation reduces HIV infection. It synthesises qualitative implementation experiences, and the included studies did not measure client adherence, retention or HIV incidence.