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Expanding PrEP Access Through Decentralized Delivery Models
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Published: 17 April 2026
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Key challenges to PrEP use include structural barriers, such as long distances to PrEP clinics, difficulties in scheduling visits, and challenges obtaining and collecting prescriptions [9, 10]. Stigma associated with HIV and sexuality further hinders access for some key populations [11, 12].
In addition, healthcare practitioners frequently face barriers to prescribing PrEP, including limited training, resources, and time, as well as, in some settings, constrained drug supply. Complex clinical monitoring requirements and lengthy clinic visits can also discourage initiation and adherence to PrEP among users [9–13]. Together, these barriers limit PrEP uptake, persistence, and overall effectiveness, underscoring the need for innovative delivery strategies, such as expanding the range of providers authorized to prescribe PrEP and diversifying service delivery models, to improve the acceptability of PrEP delivery and downstream clinical outcomes [12].
Purpose of review
This review examines emerging PrEP delivery models designed to expand access to HIV prevention outside of traditional clinic settings. It aims to synthesize recent evidence from these models on PrEP uptake, acceptability, and persistence, as well as geographic, social, and structural challenges, drawing on both the research literature and insights from recent programs.
Recent findings
Recent studies have highlighted the potential of decentralized PrEP delivery approaches, including community-based distribution, pharmacy-based PrEP provision, telePrEP, and automated PrEP dispensing. These models can improve access, reduce stigma, and provide more personalized care. Hybrid approaches and integration of digital tools and peer support have also shown promise in enhancing adherence and retention. However, challenges related to effectiveness, scalability, regulatory constraints, and cost-effectiveness remain.
Summary
Decentralized PrEP delivery models offer flexible, client-centered solutions that can significantly expand access to HIV prevention for vulnerable groups. Future research should focus on implementation and policy innovation to support integratration of these models into existing health systems and reach underserved populations. Hybrid delivery approaches that combine telemedicine, HIV self-testing, courier distribution, and community-based support offer potential to enhance flexibility and autonomy, but they remain largely in the pilot or demonstration phase of development.
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