Systematic review of the values and preferences regarding the use of injectable pre-exposure prophylaxis to prevent HIV acquisition.

Autor: Lorenzetti L; Global Health and Population Research, FHI 360, Durham, North Carolina, USA., Dinh N; Global Health and Population Research, FHI 360, Durham, North Carolina, USA., van der Straten A; ASTRA Consulting, Kensington, California, USA.; Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA., Fonner V; Global Health and Population Research, FHI 360, Durham, North Carolina, USA., Ridgeway K; Global Health and Population Research, FHI 360, Durham, North Carolina, USA., Rodolph M; World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland., Schaefer R; World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland., Schmidt HA; World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland.; UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand., Baggaley R; World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: Journal of the International AIDS Society [J Int AIDS Soc] 2023 Jul; Vol. 26 Suppl 2, pp. e26107.
DOI: 10.1002/jia2.26107
Abstrakt: Introduction: Pre-exposure prophylaxis (PrEP) is an important HIV prevention option. Two randomized trials have provided efficacy evidence for long-acting injectable cabotegravir (CAB-LA) as PrEP. In considering CAB-LA as an additional PrEP modality for people at substantial risk of HIV, it is important to understand community response to injectable PrEP. We conducted a systematic review of values, preferences and perceptions of acceptability for injectable PrEP to inform global guidance.
Methods: We searched nine databases and conference websites for peer-reviewed and grey literature (January 2010-September 2021). There were no restrictions on location. A two-stage review process assessed references against eligibility criteria. Data from included studies were organized by constructs from the Theoretical Framework of Acceptability.
Results: We included 62 unique references. Most studies were observational, cross-sectional and qualitative. Over half of the studies were conducted in North America. Men who have sex with men were the most researched group. Most studies (57/62) examined injectable PrEP, including hypothetical injectables (55/57) or placebo products (2/57). Six studies examined CAB-LA specifically. There was overall interest in and often a preference for injectable PrEP, though there was variation within and across groups and regions. Many stakeholders indicated that injectable PrEP could help address adherence challenges associated with daily or on-demand dosing for oral PrEP and may be a better lifestyle fit for individuals seeking privacy, discretion and infrequent dosing. End-users reported concerns, including fear of needles, injection site pain and body location, logistical challenges and waning or incomplete protection.
Discussion: Despite an overall preference for injectable PrEP, heterogeneity across groups and regions highlights the importance of enabling end-users to choose a PrEP modality that supports effective use. Like other products, preference for injectable PrEP may change over time and end-users may switch between prevention options. There will be a greater understanding of enacted preference as more end-users are offered anti-retroviral (ARV)-containing injectables. Future research should focus on equitable implementation, including real-time decision-making and how trained healthcare providers can support choice.
Conclusions: Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle.
(© 2023 World Health Organization; licensed by International AIDS Society. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
Databáze: MEDLINE
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