A Systematic Review of Pre-Exposure Prophylaxis (PrEP) Intervention Studies Implemented Targeting Adolescents and Young Adults Aged 15-29 in Sub-Saharan Africa: RE-AIM-Ing 4 PrEP

Background: PrEP is a highly effective HIV prevention method that uses antiretroviral drugs yet its delivery targeting adolescents and young adults (AYAs) in sub-Saharan Africa (SSA) is progressing slowly. No published systematic review studies have used RE-AIM framework to evaluate implementation outcomes for PrEP interventions in SSA settings. This review assessed the reporting of implementation outcomes for PrEP interventions that targeted AYA in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.

Methods: We searched PubMed, CINAHL, Scopus, Google Scholar, and Embase for PrEP interventions for AYAs in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions was summarized and synthesized across included interventions.

Results: A total of 09 unique interventions met the predefined eligibility criteria. Adoption n=8(91%) was the highest reported RE-AIM domain followed by Reach n=07(81.2%), effectiveness n=6(76%), implementation n=5(59%) and maintenance n=5(36.6%). All nine interventions reported on the following RE-AIM components: Inclusion criteria, sample size, characteristics of participants, measures/results for at least one follow-up, baseline activity measured, description of intervention location, intervention duration, and frequency. Both measures of the cost of implementation and quality-of-life measure components were reported poorly at n=1(11%). Other components reported poorly include intervention fidelity, characteristics of non-participants, and method to identify target delivery agents at 6(66.7%). No study reported on individual-level indicators for maintenance n=0(0.0%).

Conclusions: Findings highlight the need for more comprehensive reporting on all RE-AIM components to understand strategies for PrEP intervention effectiveness and sustainability for AYA in SSA settings. Implementation efforts should focus on rigorous design and monitoring to ensure long-term effectiveness and sustainability, including intervention fidelity and cost-effectiveness. Policymakers should consider the full spectrum of RE-AIM components when designing and implementing interventions, prioritizing those with demonstrated effectiveness, reach, and adoption, while also considering long-term maintenance and cost-effectiveness.