Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas. OBJECTIVE: The present study presents a scoping review of the self-reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States. DESIGN: Preferred Items for Systematic Reviews-Extension for Scoping Reviews (PRISMA-ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP. RESULTS: From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care. CONCLUSIONS: Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co-pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Health services
  • Stigma/discrimination
• Population(s)
  • Men who have sex with men
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
• Prevention
  • Sexual risk behaviour
  • Biomedical interventions
  • Education/media campaigns
• Testing
  • Testing
• Health Systems
  • Delivery arrangements