Effectiveness of Integrating HIV Oral Pre-exposure Prophylaxis (PrEP) and Family Planning: A Systematic Review of Initial Implementation Efforts in Low- and Middle-Income Countries.

Oral pre-exposure prophylaxis (PrEP) and family planning (FP) share key characteristics. Both are preventive, both have high efficacy but effectiveness which can be diminished by inconsistent use and both are particularly beneficial for adolescent girls and young women (AGYW) in certain lower- and middle-income countries. When the efficacy of PrEP was proven in field trials, an effort to implement PrEP programs for the populations that would most benefit from it was launched. For AGYW, making PrEP available through existing FP services was seen as a natural opportunity for integration and was the primary effort and until recently, only experience in implementation of PrEP for AGYW. In this systematic review, we attempted to discover whether the integrated delivery of PrEP and FP results in the uptake and consistent use of either or both interventions. We found that no studies that met our inclusion criteria as no valid comparison for a PrEP/FP integration was discovered. Nonetheless, valuable information on the feasibility and acceptability of PrEP was gleaned from some of these studies, much less on the impact of PrEP promotion on FP acceptance and use. Providing PrEP to eligible individuals is an urgent public health priority. Doing so while enhancing uptake and use of FP is equally important. Future studies would benefit from a more encompassing view of this important integration.