Global Perspectives on Pre-Exposure Prophylaxis: A Systematic Review and Meta-Analysis of Health Care Providers’ Awareness, Willingness, and Barriers

Abstract

This systematic review and meta-analysis aimed to assess health care providers' awareness, willingness, and key barriers in implementing HIV pre-exposure prophylaxis (PrEP). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024620671). A comprehensive search was conducted across major databases, and the eligible studies published between May 2014 and November 2024 were selected based on predefined inclusion and exclusion criteria. Participants were primarily health care providers involved in the adult PrEP care, with some studies also including providers caring for adolescents. A total of 23 cross-sectional studies comprising 6977 participants from various regions were included. The pooled awareness rate of health care providers regarding HIV PrEP was 89% (95% confidence interval [CI]: 85-93%), while their willingness to prescribe PrEP was 70% (95% CI: 65-75%). Providers with experience in caring for at least one HIV-positive patient (odds ratio [OR] = 1.35, 95% CI: 1.02-1.68) and those with greater knowledge (OR = 1.60, 95% CI: 1.06-2.14) demonstrated higher odds of prescribing PrEP. Despite the high level of awareness, the pooled willingness to prescribe PrEP was suboptimal, indicating limited adoption. The findings identify a small but critical group of less-aware providers who represent a key target for awareness and training initiatives. Barriers to PrEP implementation were identified at individual, community, and structural levels, including limited training, concerns about toxicity and resistance, discomfort with sexual health discussions, and low acceptance among both providers and patients. Targeted interventions addressing these barriers are essential to enhance PrEP uptake and optimize HIV prevention efforts globally.