title: Defining the HIV pre-exposure prophylaxis care continuum.
abstract: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. There is little scientific consensus about how to measure PrEP program implementation progress. We draw on several years of experience in implementing PrEP programs and propose a PrEP continuum of care that includes: (1) identifying individuals at highest risk for contracting HIV, (2) increasing HIV risk awareness among those individuals, (3) enhancing PrEP awareness, (4) facilitating PrEP access, (5) linking to PrEP care, (6) prescribing PrEP, (7) initiating PrEP, (8) adhering to PrEP, and (9) retaining individuals in PrEP care. We also propose four distinct categories of PrEP retention in care that include being: (1) indicated for PrEP and retained in PrEP care, (2) indicated for PrEP and not retained in PrEP care, (3) no longer indicated for PrEP, and (4) lost to follow-up for PrEP care. This continuum of PrEP care creates a framework that researchers and practitioners can use to measure PrEP awareness, uptake, adherence, and retention. Understanding each point along the proposed continuum of PrEP care is critical for developing effective PrEP interventions and for measuring public health progress in PrEP program implementation.
authors.affiliation: aDepartment of Behavioral and Social Sciences, School of Public Health, Brown University bThe Warren Alpert Medical School, Brown University cDivision of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island dDepartment of Social Medicine eCenter for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina fFrancis I. Proctor Foundation, University of California, San Francisco gThe Fenway Institute hThe Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts iThe Division of Infectious Disease, School of Medicine, Washington University, Washington.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nunn
authors.forename: Lauren
authors.initials: L
authors.lastname: Brinkley-Rubinstein
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Matthew
authors.initials: M
authors.lastname: Mimiaga
authors.forename: Rupa
authors.initials: R
authors.lastname: Patel
authors.forename: Philip A
authors.initials: PA
authors.lastname: Chan
mesh_terms: D003266:Continuity of Patient Care / Q000458:organization & administration*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D065129:Pre-Exposure Prophylaxis / Q000379:methods*