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The paper examines key implementation elements to expand uptake among at-risk populations, including increasing access, integrating PrEP with other sexual health services, promoting persistence, and establishing systems to monitor PrEP use. It emphasizes that uptake levels drive public health impact and highlights barriers across populations, including gaps in awareness, guideline sensitivity, stigma, and cost concerns.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/getting-prep-to-the-people-opportunities-challenges-and-emerging-models-of-prep-implementation/400881/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/getting-prep-to-the-people-opportunities-challenges-and-emerging-models-of-prep-implementation/400881.png","ImageObject",300,407,{"name":92,"@type":93},"Pentious","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-27",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is PrEP uptake often insufficient to reduce HIV incidence?","Question",{"text":112,"@type":113},"Even with proven efficacy, many jurisdictions have not achieved adequate coverage. The paper explains that barriers in access, integration, persistence, and monitoring limit uptake and therefore population-level impact.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What implementation elements does the paper highlight to expand PrEP uptake?",{"text":117,"@type":113},"It focuses on increasing access to PrEP, integrating PrEP programs with other sexual health services, promoting PrEP persistence after prescription, and developing systems for monitoring PrEP use.",{"name":119,"@type":110,"acceptedAnswer":120},"What barriers prevent people at substantial risk from starting PrEP?",{"text":121,"@type":113},"Common barriers include limited risk perception and misunderstanding of indications (such as STI diagnosis). The paper also notes guideline sensitivity concerns for Black MSM and barriers for women related to stigma, medication costs, and fears involving family members or providers.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},400881,1790673148,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1374404730887,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Author Manuscript Author Manuscript Author Manuscript Author Manuscript  \n\n| | HHS Public Access\u003Cbr>Author manuscript\u003Cbr>Sex Health. Author manuscript; available in PMC 2019 November 01. |\n| --- | --- |\n\nPublished in final edited form as:  \nSex Health. 2018 November ; 15(6): 522–527. doi:10.1071/SH18103 .  \nGetting PrEP to the people: opportunities, challenges, and emerging models of PrEP implementation  \nPatrick S SullivanA and Aaron J SieglerB  \nA Department of Epidemiology, Rollins School of Public Health, Emory University B Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University  \nAbstract  \nBackground/Purpose: Pre-exposure prophylaxis with TDF/FTC is now accepted as an efficacious approach to preventing HIV acquisition among people at high risk for HIV infection, but in most places, PrEP uptake to date has not been sufficient to make large impacts on HIV incidence.  \nApproach: Here we consider several key elements of the effort to expand PrEP uptake for at-risk populations who would benefit most: Increasing access to PrEP, integrating PrEP programs with other services, promoting PrEP persistence, and developing systems for monitoring PrEP use.  \nOutcomes/Impact: Access to PrEP includes regulatory issues and geographic proximity to PrEP providers. Integrating PrEP programs with other comprehensive sexual health services, through clinic-based programs or through technology-based approaches, offers opportunities to identify PrEP candidates and improve linkages to PrEP care. Once at-risk people are prescribed PrEP, lowering barriers to persistence on PrEP is critical to realizing the most population benefits. To understand progress and identify under-served groups and communities, systems to monitor the uptake of PrEP are needed.  \nSignificance/Innovation: We argue that making the most of a new biomedical intervention tool requires ongoing research about implementation, scaleup through multiple channels, including community-based organizations, and high-quality monitoring of uptake. We must turn to questions of PrEP implementation and continue to seek innovative approaches to reduce barriers to PrEP uptake and persistence on PrEP.  \nIt is now clear that daily pre-exposure prophylaxis with TDF/FTC is effective in reducing HIV acquisition for men who have sex with men (MSM), people who inject drugs, and heterosexual couples. The public health impact of PrEP on HIV epidemics will be largely driven by the extent of uptake of PrEP for people at substantial risk for HIV infection. Modeling studies conducted to estimate the impact of varying levels of PrEP on HIV incidence in MSM suggest that 30%−50% coverage of PrEP among MSM with PrEP indications would be required to achieve reductions in HIV incidence of 25%.(1–3) Few health jurisdictions have achieved this level of PrEP coverage; in a national sample of MSMin the United States, less than 10% of surveyed MSM in 2014 reported ever having used PrEP. Some jurisdictions, such as Seattle (4), San Francisco(5), Sydney, Melbourne(6), and Chicago(7) have reported PrEP uptake as high as 16–30% in specific service populations.  \nAuthor Manuscript Author Manuscript Author Manuscript Author Manuscript  \nSullivan and Siegler Page 2  \nDespite increases in PrEP use and moderate levels of coverage in some cities, significant barriers to increasing PrEP among those at substantial risk for HIV remain. A case series of MSM who became newly infected with HIV while they were in a research study in which PrEP was offered to participants every 3–6 months, lack of risk perception and lack of understanding of PrEP indications (e.g., STI diagnosis) were common reasons for not starting PrEP when it was recommended. Further, the 2014 Public Health Service PrEP guidelines may be less sensitive for identifying Black MSM at risk for HIV infection, compared to sensitivity for identifying white MSM at risk.(8) For women at risk for HIV, concerns about stigma and ","cbCaiuf0c2OaLFcf","https://ap.wps.com/l/cbCaiuf0c2OaLFcf","pdf",61262,"English","# Abstract\n## Background/Purpose\n## Approach\n## Outcomes/Impact\n## Significance/Innovation\n# Barriers and required responses\n## PrEP coverage and impact\n## Uptake barriers among key groups\n# Improving access to PrEP\n## Regulatory policies and healthcare access","[{\"question\":\"Why is PrEP uptake often insufficient to reduce HIV incidence?\",\"answer\":\"Even with proven efficacy, many jurisdictions have not achieved adequate coverage. The paper explains that barriers in access, integration, persistence, and monitoring limit uptake and therefore population-level impact.\"},{\"question\":\"What implementation elements does the paper highlight to expand PrEP uptake?\",\"answer\":\"It focuses on increasing access to PrEP, integrating PrEP programs with other sexual health services, promoting PrEP persistence after prescription, and developing systems for monitoring PrEP use.\"},{\"question\":\"What barriers prevent people at substantial risk from starting PrEP?\",\"answer\":\"Common barriers include limited risk perception and misunderstanding of indications (such as STI diagnosis). The paper also notes guideline sensitivity concerns for Black MSM and barriers for women related to stigma, medication costs, and fears involving family members or providers.\"}]","Getting PrEP to the people - opportunities, challenges, and emerging models of PrEP implementation | PDF",1790514960,23]