Public health implications of adapting HIV pre-exposure prophylaxis programs for virtual service delivery in the context of the COVID-19 pandemic: A systematic review

BACKGROUND: The novel coronavirus disease-19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) threatens to disrupt global progress towards HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. OBJECTIVE: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. We describe adaptations that could address potential COVID-19-related service interruptions. METHODS: We conducted a systematic review and searched six databases: OVID/Medline, Scopus, Cochrane Library, CINAHL, PsychInfo, and Embase for studies published between January 1, 2010, and October 26, 2021 for recent technology-based interventions for virtual service delivery. Search terms included “telemedicine, telehealth, mobile health, ehealth, mhealth, telecommunication, social media, mobile device, internet” among others. Of the 6,685 abstracts identified, 1,254 focused on HIV virtual service delivery and of those, 120 were relevant for HIV prevention efforts; 48 were pertaining to PrEP and 19 of these focused on evaluations of interventions for virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies’ methodological approaches and outcomes; thus, a meta-analysis was not conducted. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. RESULTS: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone applications such as iText (50% [95%CI: 16–71%]) reduction in discontinuation of PrEP) and PrEPmate (OR=2.62. 95%CI:1.24–5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as ECHO. We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications and internet for monitoring. CONCLUSIONS: Innovations in virtual service provision of PrEP occurred before COVID-19 but have new relevance in the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long-run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible healthcare platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services and be leveraged to facilitate COVID-19 pandemic control now and for future responses.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Health services
• Population(s)
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Biomedical interventions
  • Education/media campaigns
• Health Systems
  • Delivery arrangements