A rapid review of pre-exposure prophylaxis for HIV in the Asia–Pacific region: recommendations for scale up and future directions

Partha Haldar; Sushena Reza-Paul; Roy Arokiam Daniel; Lisa Lazarus; Bharat Bhushan Rewari; Robert Lorway; R. Steen

doi:10.1071/SH20058

REVIEW

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A rapid review of pre-exposure prophylaxis for HIV in the Asia–Pacific region: recommendations for scale up and future directions

Partha Haldar

^A , Sushena Reza-Paul

^B ^E , Roy Arokiam Daniel

^A , Lisa Lazarus ^B , Bharat Bhushan Rewari ^C , Robert Lorway ^B and R. Steen ^D

+ Author Affiliations

- Author Affiliations

^A All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India.

^B University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada.

^C World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India.

^D Erasmus Medical Center, Department of Public Health, Rotterdam, Zuid-Holland, Netherlands.

^E Corresponding author. Email: sushenar@gmail.com

Sexual Health 18(1) 31-40 https://doi.org/10.1071/SH20058
Submitted: 9 April 2020 Accepted: 13 January 2021 Published: 26 February 2021

Abstract

Decline in new HIV infections in the Asia–Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.

Keywords: Asia–Pacific, HIV prevention, pre-exposure prophylaxis, prevention, feasibility, PrEP, availability, acceptability, combination–prevention.

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A rapid review of pre-exposure prophylaxis for HIV in the Asia–Pacific region: recommendations for scale up and future directions

Abstract

References

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