Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 23, 2022
Date Accepted: Apr 27, 2022
Date Submitted to PubMed: Apr 29, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
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
ABSTRACT
Background:
: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed.
Objective:
We describe adaptations that could address potential COVID-19-related service interruptions.
Methods:
We conducted a systematic review and searched the OVID/Medline, Scopus, Cochrane Library, CINAHL, PsychInfo, Embase, and Global Health databases for studies published between January 1, 2010, and October 26, 2021. Search terms included “telemedicine, telehealth, mobile health, ehealth, mhealth, telecommunication, social media, mobile device, internet”. Of 6685 abstracts identified, 1,259 were specific to virtual service delivery for HIV, with 8 for preexposure prophylaxis (PrEP), and reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of studies; thus, a meta-analysis was not conducted. The quality of the evidence was assessed using the Cochrane risk bias tool. Studies with missing data were excluded.
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 and how it can be leveraged for COVID-19 service delivery. Examples of using innovations for both PrEP and COVID-19 include: (1) social media platforms for public health messaging; (2) decentralized care using telehealth platforms; (3) web-based platforms for training of health care workers; (4) web-based and application-based data entry for monitoring and evaluation.
Conclusions:
Virtual service delivery is possible in the context of COVID-19 and might strengthen HIV prevention service delivery in the long-run. These platforms can also be leveraged for COVID-19 service delivery. Clinical Trial: N/A
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