Effectiveness of PrEP Initiation Among Priority Populations in Sub-Saharan Africa: Evidence from a Systematic Review and Meta-analysis

Abstract

Effectiveness of PrEP Initiation Among Priority Populations in Sub-Saharan Africa: Evidence from a Systematic Review and Meta-analysis

BACKGROUND:
Pre-exposure prophylaxis (PrEP) is a key HIV prevention strategy for priority populations in sub-Saharan Africa, where HIV incidence remains high and access to prevention services is influenced by stigma, health system constraints, and variability in service delivery.

AIM:
To assess the effectiveness of PrEP initiation strategies compared with standard-of-care HIV prevention approaches among priority populations in sub-Saharan Africa.

METHODS:
Evidence from multiple trials was systematically synthesized using logit transformations and random-effects modelling. Statistical heterogeneity was assessed using the I² statistic.

RESULTS:
The pooled estimate demonstrated high PrEP initiation across included studies, with a 95% confidence interval of 0.82 to 0.95, indicating consistently strong uptake of PrEP among priority populations. Moderate heterogeneity was observed (I²), suggesting variability in uptake across studies due to differences in delivery models, population characteristics, and implementation settings. Subgroup analyses indicated that community-based and integrated service delivery models achieved higher initiation rates compared to facility-based standard-of-care approaches. Studies that incorporated tailored demand creation strategies, peer support, and differentiated service delivery approaches reported particularly high uptake, especially among adolescent girls and young women and serodiscordant couples. In contrast, lower initiation rates were observed in settings with limited health system capacity or where PrEP awareness was low. Overall, multivariable analyses confirmed that innovative PrEP delivery approaches significantly outperformed standard prevention services across diverse geographical contexts.

CONCLUSION: PrEP initiation strategies are effective in increasing access to HIV prevention among priority populations in sub-Saharan Africa. However, scale-up should be context-specific, taking into account health system capacity, implementation context, and infrastructure variability.

KEYWORDS: PrEP initiation; HIV prevention; sub-Saharan Africa; priority populations; systematic review; meta-analysis.

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