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Table 2 Overview of the included literature

From: The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

# Author & Year Title Study Type Geographic Focus or Setting PrEP Service Delivery Model
Service Delivery Setting PrEP Provider Delivery Channel
1 Finkenflügel et al., 2019 [22] A Mobile Application to Collect Daily Data on Preexposure Prophylaxis Adherence and Sexual Behavior Among Men Who Have Sex With Men: Use Over Time and Comparability With Conventional Data Collection Quantitative Usability & Feasibility Pilot Implementation Study Amsterdam, The Netherlands Research conducted in one STI outpatient clinic as part of the AmPrEP research study setting. Study staff (health care worker training not specified) 3-monthly PrEP prescriptions obtained through in-person visits. In-between follow-up on adherence and sexual behavior through the use of a mobile application.
2 Fuchs et al., 2018 [23] A Mobile Health Strategy to Support Adherence to Antiretroviral Preexposure Prophylaxis Mixed Methods Usability, Acceptability & Feasibility Pilot Implementation Study San Francisco & Chicago, USA Research conducted in a research study setting as part of the iPrEx OLE study. Study staff (health care worker training not specified) 3-monthly PrEP prescriptions obtained through in-person visits. In-between adherence support provided through the use of bidirectional text or e-mail messages.
3 Brown et al., 2018 [24] Challenges and solutions implementing an SMS text message-based survey CASI and adherence reminders in an international biomedical HIV PrEP study (MTN 017) Mixed Methods Pilot Implementation Study USA, Thailand, Peru, South Africa Research conducted in a research study setting as part of the MTN 017 phase 2 trial. Study staff (health care worker training not specified) Oral or rectal PrEP provided through in-person visits. SMS-CASI system used to provide real-time in-between visits adherence support
4 Puppo et al., 2019 [25] Community-Based Care in the ANRS-IPERGAY Trial: The Challenges of Combination Prevention Qualitative Adherence Evaluation Study France & Canada Research conducted in a research study setting as part of the ANRS-IPERGAY (OLE) trial. Study staff (health care worker training not specified) prescribed oral PrEP. CBHW provide permanently available peer-based care. PrEP prescriptions provided through in-person visits. Community-based support was permanently available as in-person visits with a personally assigned CBHW.
5 Sharma et al., 2018 [26] Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol Protocol for a Pilot Implementation Study Toronto, Canada PrEP to be provided at family physician’s private practice or in sexual health clinics. Family physicians and nurse practitioners in sexual health clinics provide PrEP prescriptions and related care PrEP prescriptions provided through in-person visits with family physicians after receiving PICME or at the sexual health clinic for people with no family physician.
6 Siegler et al., 2019 [27] Developing and Assessing the Feasibility of a Home-based Preexposure Prophylaxis Monitoring and Support Program Implementation Pilot Study San Francisco & Boston, USA PrEP users receive care at home, replacing 3 out of 4 usually in-person visits Clinicians (training not specified) at a variety of clinical settings provide PrEP prescriptions STI/HIV sampling and testing kits sent to the user’s home with counseling and communication of test results over the phone. PrEP prescriptions sent to user’s home.
7 Liu et al., 2014 [28] Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco Descriptive Report San Francisco, USA 1) PrEP demonstration project in a municipal STD clinic 2) PrEP program in a private health maintenance organization 3) PrEP delivery in a HIV-specific reproductive health program 1) Study staff (health care worker training not specified) 2) Prescription by HIV specialists, referrals by PCP 3) Health care worker training not specified 1) Oral PrEP provided through in-person visits in a study setting offering a range of sexual health services 2) Oral PrEP provided through regular in-person visits 3) Oral PrEP provided to HIV-negative women who are having sex with an HIV-positive male partner through in-person visits
8 Vuylsteke et al., 2018 [29] High uptake of pre-exposure prophylaxis (PrEP) during early roll-out in Belgium: results from surveillance reports Descriptive Report Belgium Oral PrEP provided through specialized HIV clinics. Oral PrEP prescribed by HIV-specialists affiliated to specialized HIV clinics. Oral PrEP provided through in-person visits via 11 centralized HIV reference centers across Belgium.
9 Girometti et al., 2018 [30] Evolution of a pre-exposure prophylaxis (PrEP) service in a community-located sexual health clinic: concise report of the PrEPxpress Descriptive Report London, United Kingdom Oral PrEP provided through a specialized sexual health clinic as part of the NHS-led 3-year IMPACT implementation trial. Nurses provide oral PrEP per medical directive. Other trained healthcare workers are involved in monitoring and health promotion activities. Referral of complex cases to a physician-led consultation. Oral PrEP provided through in-person visits. Clients can self-sample for STIs with test results provided via text message.
10 National AIDS & STI Control Programme (NASCOP), 2017 [31] Framework for the Implementation of Pre-Exposure Prophylaxis of HIV In Kenya National Implementation Framework Kenya Efforts to integrate oral PrEP service delivery horizontally in the Kenyan health system by strengthening existing services and reinforce linkage between complementary services such as reproductive health. PrEP prescription and dispension by trained healthcare providers including physicians, clinical officers, nurses, pharmacists and pharmaceutical technologists. Oral PrEP provided through in-person visits using both community-based and facility-based delivery models.
11 Hood et al., 2018 [32] Getting pre-exposure prophylaxis to high-risk transgender women: lessons from Detroit, USA Descriptive Report Detroit, USA Oral PrEP provided through a non-profit community health center delivering integrated and trans-friendly health services free of cost. On-site local pharmacy provides PrEP regimens, in addition to hormonal replacement therapy (HRT). Training of other health care workers involved not specified. Oral PrEP provided through in-person visits in a specialized clinical infrastructure responsive to the needs of transgender women.
12 Eakle et al., 2017 [33] HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project Quantitative Implementation Study Johannesburg & Pretoria, South Africa Oral PrEP provided in a research setting at 2 urban clinics catering a population of sex workers. PrEP prescriptions provided by a healthcare worker (training not specified). Sex Worker Program is run by nurses, community health workers and peer educators. Oral PrEP provided through in-person visits integrated in a public health clinical service program providing primary healthcare to a population of sex workers.
13 Stekler et al., 2018 [34] HIV Pre-exposure Prophylaxis Prescribing Through Telehealth Descriptive Report Seattle, USA Oral PrEP provided at a community-based gay-friendly urban health center, targeting at risk persons without insurance. PrEP prescriptions provided by physicians. Other care provided by trained HIV counselors. Oral PrEP provided through in-person visits, either after consulting with a physician that is physically present, or after videoconference call with a physician.
14 Ortblad et al., 2019 [35] HIV-1 self-testing to improve the efficiency of pre-exposure prophylaxis delivery: a randomized trial in Kenya Protocol for a randomized non-inferiority trial Thika, Kenya Oral PrEP is provided in a research setting at an urban HIV clinic providing comprehensive HIV prevention and STI services. PrEP prescriptions provided by study clinicians and PrEP is being dispensed by on-site pharmacists. Oral PrEP provided through in-person visits. Introducing and testing of a service delivery model whereby HIV self-testing through oral vs. blood self-collection at home replaces one out of two of the quarterly clinic visits.
15 Tung et al., 2018 [36] Implementation of a community pharmacy-based pre-exposure prophylaxis service a novel model for pre-exposure prophylaxis care Descriptive Report Seattle, USA Oral PrEP provided through a community-based pharmacy. Oral PrEP prescribed and provided by clinical pharmacist as per collaborative drug therapy agreement (CDTA) between physician and pharmacist. Referral to physician for complex cases. Oral PrEP provided through in-person pharmacy visits under supervision of a physician medical director. STI samples collected through self-sampling, blood samples drawn by pharmacist.
16 Health Protection Scotland and Information Services Division, 2019 [37] Implementation of HIV PrEP in Scotland: First Year Report National Implementation Report Scotland, United Kingdom Oral PrEP provided exclusively in an existing network of specialized sexual health services. Oral PrEP prescribed and dispensed by health care workers (training not specified) Oral PrEP provided through in-person visits.
17 Ministry Of Health and Child Care, 2017 [38] Implementation Plan for HIV Pre-Exposure Prophylaxis in Zimbabwe National Implementation Plan Zimbabwe Plan to provide oral PrEP through phased facility roll-out with initial focus on existing facilities already serving key populations and other individuals at substantial risk of HIV acquisition. Oral PrEP prescribed by health care workers in existing facilities providing HIV prevention services (provider training not specified). Oral PrEP provided through in-person visits with focus on decentralizing PrEP services with a priority for high-incidence districts through existing systems.
18 Saxton et al., 2018 [39] Implementing HIV pre-exposure prophylaxis (PrEP): Let’s not get caught with our pants down Viewpoint New Zealand Oral PrEP provided through licensed HIV prescribers. Oral PrEP prescribed and reimbursed through approved HIV prescribers. 3-monthly repeats can be provided by physicians and nurse practitioners after having received a PrEP training. Oral PrEP provided through in-person visits.
19 Roesch et al., 2019 [40] Implementing Pre-exposure Prophylaxis for HIV Prevention at an Urban Youth Clinic Descriptive Report Minnesota, USA Oral PrEP provided at an urban community serving youth (age 11–24 years) regardless of ability to pay. All PrEP care provided through nurse practitioners after having received a PrEP training course. Oral PrEP provided through in-person visits
20 Pintye et al., 2018 [41] Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya Pilot Implementation Study Kisumu, Kenya Oral PrEP provided in a research setting through a public or private sector antenatal or postnatal care clinic. All PrEP-specific services provided by nurses within the ANC/PNC clinic. Option between co-delivery of PrEP service by same nurse offering maternal services or sequentially by a specialized PrEP nurse. Oral PrEP provided through in-person visits.
21 Hoth et al., 2019 [42] Iowa TelePrEP: A Public-Health-Partnered Telehealth Model for Human Immunodeficiency Virus Preexposure Prophylaxis Delivery in a Rural State. Descriptive Report Iowa, USA PrEP care provided through videoconference in community settings or at people’s home. TelePrEP pharmacists clinically assessed, educated and prescribed PrEP through videoconference. Clients were self-referred or referred by TelePrEP navigators when expressed interest in PrEP. Oral PrEP was provided without need for in-person visits. All PrEP care was provided via videoconference, with laboratory testing performed in community laboratories and PrEP regimens sent to the user’s home.
22 Schmidt et al., 2018 [43] Nurse-led pre-exposure prophylaxis: a non-traditional model to provide HIV prevention in a resource-constrained, pragmatic clinical trial Descriptive Report Sydney, Australia Oral PrEP provided in a research setting at public clinics. Trained and authorized registered nurses provide PrEP care and supply PrEP under standing order or following prescription by a physician. Oral PrEP provided through in-person visits at public clinics participating in the EPIC-NSW trial.
23 Masyuko et al., 2018 [44] Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study Case Study Kenya Oral PrEP provided in an integrated fashion in a variety of existing infrastructures such as HIV testing sites, HIV clinics, out-patient departments and maternal health care sites. PrEP care can be initiated by a qualified and skilled health care provider with different (clinical) backgrounds. Oral PrEP is provided through in-person visits.
24 Refugio et al., 2019 [45] PrEPTECH: A Telehealth-Based Initiation Program for HIV Pre-exposure Prophylaxis in Young Men of Color Who Have Sex With Men. A Pilot Study of Feasibility Quantitative Pilot Feasibility Study San Francisco, USA Oral PrEP provided through home-based telehealth visits. PrEP care provided through an infectious disease physician over telephone. Clients receive STI sampling kits at home. Oral PrEP is provided without the need for an in-person visit. Counseling and support is provided via telehealth visits, STI and HIV sampling is done via self-sampling and/or at nearby laboratories. PrEP regimens are sent to clients’ home.
25 Phanuphak et al., 2018 [46] Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand Descriptive Report Thailand Oral PrEP provided through 8 gay-friendly community health centers. PrEP services, including HIV and STI testing, counseling and dispensing of regimens are being provided by trained key-population community health workers. Oral PrEP provided through in-person visits in a community setting. Laboratory results are reviewed by a physician, complex cases and contra-indications for PrEP are referred to a physician. Visit reminders were sent via social networking platforms.
26 Bien et al., 2017 [47] Reaching Key Populations: PrEP Uptake in an Urban Health Care System in the Bronx, New York Descriptive Report The Bronx, NYC, USA Oral PrEP provided through a variety of clinical settings (predominantly primary care providers, next to sexual health clinics and women’s health centers), comprising together the urban health system of The Bronx. PrEP care was provided through a variety of health care workers (training not specified). Oral PrEP was provided through in-person visits.
27 Kamis et al., 2019 [48] Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care Quantitative Feasibility and Acceptability Pilot Implementation Study Denver, USA Oral PrEP provided through a large metropolitan STD clinic. PrEP care provided by a nurse practitioner or nurse together with a physician. A patient navigator provided PrEP education an PrEP was dispensed through an on-site pharmacy. Oral PrEP was provided through in-person visits on the same day PrEP eligibility was first assessed.
28 Marcus et al., 2016 [49] Successful Implementation of HIV Preexposure Prophylaxis: Lessons Learned From Three Clinical Settings Review San Francisco, USA Oral PrEP provided in 3 different clinical settings in a metropolitan city. Oral PrEP was provided by 1) infectious disease specialists or trained pharmacists 2) nurses in an STI clinic as part of a demonstration project 3) primary care practitioners, sending PrEP prescriptions to the preferred pharmacy of the client. Oral PrEP was provided through in-person visits.
29 Walmsley et al., 2019 [50] The PrEP You Want: A Web-Based Survey of Online Cross-Border Shopping for HIV Prophylaxis Medications Quantitative Survey Study Ontario, Canada Oral PrEP provided through online ordering and shipping to a US mailbox. Prescription for oral PrEP is obtained from a local Canadian health care provider and then shipped across the border to a US mailbox for pick-up. Oral PrEP was provided without need for in-person visits. After obtaining a valid prescription, PrEP was ordered online and accessed using a border-crossing approach to bypass required co-payments in some Canadian jurisdictions.
30 Eccles-Radtke et al., 2015 [51] Turning the Tide against AIDS by Preventing New HIV Infections: Initial Experience with Minnesota’s First PrEP Clinic Descriptive Report Minnesota, USA Oral PrEP was provided at a local county medical center. Oral PrEP was provided and dispensed on-site. Training of health care providers involved was not specified. Oral PrEP was provided through in-person visits.
31 Liu et al., 2019 [52] Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Preexposure Prophylaxis Among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study RCT efficacy study Chicago, USA Oral PrEP was provided in a research setting at a large public health clinic focused on HIV prevention. Oral PrEP was delivered by on-site study clinicians (training not specified). Oral PrEP was provided through in-person visits. Study participants of the intervention arm received PrEPmate, an mHealth application delivering information on PrEP, peer testimonials, online support forum, pill reminders and check-in messages.
32 National Department of Health, 2016 [53] Guidelines for Expanding Combination Prevention and Treatment Options: Oral Pre-Exposure Prophylaxis (PrEP) and Test and Treat (T&T) National (implementation) guidelines South Africa Oral PrEP is currently provided through existing sex worker programmes and linkage to primary health care facilities. Additional delivery mechanisms and target populations will be incorporated in a phased approach. All healthcare providers affiliated with PrEP and ART service delivery should complete a PrEP implementation training program. Oral PrEP is provided through in-person visits using current platforms of ART delivery.
33 O’Byrne et al., 2019 [54] PrEP-RN: Clinical Considerations and Protocols for Nurse-Led PrEP Review Canada, USA Oral PrEP is provided through a STI clinic. Oral PrEP care is being provided by registered nurses as per medical directive. After 6–12 months of providing services at the STI clinic, patients are transferred to primary care for follow-up. Oral PrEP is provided through in-person visits.