We identified three potential types of PrEP continuation: (1) as prescribed (e.g., often every 3 months, could be linked or not necessarily linked to PrEP refills), (2) as needed (e.g., for stopping and restarting as periods of HIV risk change), and (3) as desired (e.g., between PrEP visits and refills). We defined PrEP continuation as continuing PrEP use following initiation, which included measurements of retention and drug refills as well as adherence (e.g., self-reported PrEP use, detectable drug levels in blood/hair/urine, pill counts). We defined PrEP initiation as the process of being prescribed and dispensed PrEP for the first time or after a long break (i.e., restarting PrEP). This included studies that used HIVST in lieu of traditional HIV testing services (HTS) as well as in addition to HTS at different time points. We included studies for extraction that focused on the use of HIVST for PrEP initiation or continuation. Additionally, HIVST could enable greater differentiated service delivery for PrEP initiation and continuation in new settings beyond the bounds of traditional healthcare facilities, such as at private pharmacies or during at-home visits. HIVST could enable individuals taking PrEP to test routinely, by replacing or complementing existing testing intervals with providers, which could potentially increase access and adherence to PrEP services. Currently, PrEP initiation is generally linked to clinic-based HIV testing services, followed by quarterly testing that accompanies PrEP refills. Currently, the WHO recommends that individuals using PrEP should test for HIV every 3 months to detect potential breakthrough infections, and that HIVST can be used as a way to maintain PrEP programs in the context of the COVID-19 pandemic. HIV self-testing (HIVST), which has been recommended as an effective HIV testing approach since 2016, has the potential to simplify and support PrEP delivery.
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