Barriers and Facilitators to Oral HIV Pre-exposure Prophylaxis Use in Australia: A Scoping Review Comparing Findings to Canada, New Zealand, and the United Kingdom.

Abstract

Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, yet various barriers limit its potential as a HIV prevention strategy. This scoping review aimed to identify and quantify determinants of oral PrEP initiation and continuation among community members, and provision by healthcare providers in Australia and comparable countries (UK, Canada, and New Zealand). Three databases were searched in January 2025 for original studies published between January 2018 and December 2024. We considered papers published in English from the four countries that contained primary research exploring determinants of PrEP initiation, continuation, and provision. Determinant codes were extracted, the number of times they appeared were counted, and were mapped to the updated Consolidated Framework for Implementation Science (CFIR 2.0). We identified 142 articles reporting 70 unique barriers (appearing 444 times in the 142 articles) and 49 unique facilitators (appearing 256 times in the 142 articles). Frequently identified PrEP initiation and continuation determinants-including cost, risk perception, stigma, and varying levels of PrEP knowledge and awareness-may substantially impact PrEP use and warrant further investigation. PrEP provision determinants highlighted opportunities for service innovation, such as through task-shifting and telehealth integration. Determinants absent from Australian literature suggest research opportunities in PrEP importation, telehealth delivery, task-shifting to other healthcare workers and peer workers, and PrEP use in the context of STI prophylaxis use. Research predominantly focused on gay, bisexual, and other men who have sex with men, indicating opportunities for more nuanced examination of diversity within this population, alongside further research with other key populations.