Rogério Meireles Pinto, LCSW, Ph.D. Professor and Associate Dean for Research University of Michigan School of Social Work 

Barriers to PReP Therapy for HIV Prevention Interview with:

Rogério Meireles Pinto, LCSW, Ph.D. Professor and Associate Dean for Research University of Michigan School of Social Work 

Dr. Pinto

Rogério Meireles Pinto, LCSW, Ph.D.
Professor and Associate Dean for Research
University of Michigan School of Social Work What is the background for this study?

Response: In order to decrease the rate of HIV infection, interventions to scale up PrEP will need to address identified barriers at multiple ecological levels. In the past decade, interventions proposed to address PrEP implementation barriers were limited to one ecological level or another (e.g., individual or community). The failure to consider interventions targeting multiple ecological levels simultaneously may help explain why PrEP implementation is lagging. This failure is also due to methodological limitations of PrEP implementation studies.This high-quality paper presents a thorough and theoretically grounded review of original research on HIV Pre-Exposure Prophylaxis (PrEP) implementation in the U.S. What are the main findings?

Response: This paper builds on and expands on another published systematic review by examining the methodological advances and limitations of PrEP implementation studies (2007-2018). We examine the extent to which the methods used to identify barriers to PrEP implementation have progressed since PrEP became a major HIV prevention strategy, and then provide specific recommendations for methodological improvements.

We analyzed 79 papers, including 51 (65%) using quantitative methods; 25 (32%) qualitative; and three (4%) mixed-methods articles. all articles identified barriers to PrEP implementation – knowledge, attitudes; and behavioral and social/structural factors. About two-thirds of articles were conducted with patients, one-third with healthcare providers, and examined cognitive constructs and behaviors of service providers or patients. Sample sizes ranged from 18 to 2297 participants. Only about one-half of articles described a conceptual approach. What should readers take away from your report?

Response: Methods used to uncover barriers to PrEP implementation have progressed since PrEP became a major HIV prevention strategy. From a preponderance of formative and descriptive small qualitative studies, currently there are larger and more predictive studies. However, there is a paucity of longitudinal and mixed methods studies, those with the best potential to illuminate future practice and policy development regarding PrEP implementation.

We have been unable to identify more than one ethnographic or observational studies that would provide details about the conditions under which patients and providers make PrEP-related decisions, and how, in turn, different decision-making strategies might influence diverse demographic patient groups to access and adhere to PrEP. The majority of studies identified lack theoretical frameworks, and thus have limitations concerning the applicability of their results. What recommendations do you have for future research as a result of this work? 

Response: We recommend that researchers consider mixed methods approaches when developing and conducting studies about PrEP implementation. With more sophisticated  methods and conceptual frameworks, researchers will be best able to identify more specific barriers that will inform interventions to address access failures at multiple ecological domains. This would in turn improve PrEP access, uptake, and adherence.  Future research should also shift from models of “cultural competency” to “structural competency” as a new approach to address structural stigma affecting the most vulnerable populations exposed to HIV.    

No disclosures


Rogério M. Pinto et al. Expanding Knowledge About Implementation of Pre-exposure Prophylaxis (PrEP): A Methodological Review, AIDS and Behavior (2019). DOI: 10.1007/s10461-019-02577-7

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Last Updated on July 15, 2019 by Marie Benz MD FAAD

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