The HIV pre-exposure prophylaxis (PrEP) care continuum is a proposed methodology for evaluating national PrEP programs on the basis of awareness, acceptability, uptake, adherence, and retention. A proposed systematic review plans to collate definitions of outcome measures used in the PrEP care continuum and describe how health equity characteristics are considered in these definitions, particularly among those at increased risk for HIV infection in high-income countries. The protocol of this systematic review was published in BMJ Open.

The PrEP care continuum was founded with the goal of evaluating the implementation of PrEP programs in high-income countries.

To be successful, PrEP programs must identify populations with low engagement and use alternative methods to increase awareness and use. Previous studies have identified that poor PrEP uptake was associated with increased PrEP costs, decreased educational achievement, and anticipated stigma.

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The systematic review will have 3 main objectives: to use real-world data from high-income countries to identify definitions of outcome measures used in the PrEP care continuum, including awareness, acceptability, uptake, adherence, and retention; to assess whether studies account for the effects of health equity characteristics when reporting outcome measures in their research; and to evaluate the quality of data sources used for capturing equity characteristics.

The researchers will search publication databases for studies of PrEP use published between January 2012 and March 2020. Two reviewers will initially screen studies for inclusion, and a third reviewer will adjudicate references in which the original reviewers were in disagreement. The study selection process will be performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The risk of study bias will be assessed by 2 reviewers using the Effective Public Health Practice Project “Quality Assessment Tool for Quantitative Studies.”

The narrative synthesis will be carried out by summarizing results of individual studies. The studies will be assessed for how they accounted for confounders and adjusted or stratified data in their analyses.

The objectives of the study were formulated in a one-off patient and public involvement session. Individuals who lived in high-income countries with a national PrEP program were eligible to participate.

The outcomes of this review will provide relevant information for health care professionals, policy makers, and commissioners about how best to evaluate national PrEP programs.


Cabecinha M, Solomon D, Rait G, Saunders J, Mohammed H, McDonagh LK. Equity considerations in outcome measures of the HIV pre-exposure prophylaxis care continuum in high-income countries: a systematic review protocol. BMJ Open. 2021;11(2):e040701. doi:10.1136/bmjopen-2020-040701