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Defining the HIV pre-exposure prophylaxis care continuum

Nunn, Amy S.; Brinkley-Rubinstein, Lauren; Oldenburg, Catherine E.; Mayer, Kenneth H.; Mimiaga, Matthew; Patel, Rupa; Chan, Philip A.

doi: 10.1097/QAD.0000000000001385

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.

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.

Correspondence to Amy S. Nunn, Sc.D., Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street. Suite 810, Providence RI 02806, USA. E-mail:

Received 1 November, 2016

Revised 29 November, 2016

Accepted 12 December, 2016

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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