Community-based PrEP delivery linked to higher willingness and risk behavior changes in MSMCommunity Based Delivery Increases PrEP Willingness for HIV Prevention
Frontiers in MedicinePublished September 12, 2026Study authors: Abeer Teeti, Issam AbuQeis, Xuan Zhang, Xiaowen WangDOI ↗Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care
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Key Takeaway
Interpret community-based PrEP delivery as associational; uptake and adherence were not significant.
This meta-analysis synthesizes observational and community-based data on community-based PrEP delivery among men who have sex with men. The scope covers PrEP willingness, positive risk behavior changes, uptake, and adherence. No sample size, follow-up duration, or comparator is reported.
The pooled results show increased PrEP willingness (OR 5.12; 95% CI 4.30-6.10) and increased positive risk behavior changes (OR 1.61; 95% CI 1.33-1.96). Uptake was not significant overall, except for a telehealth subgroup (OR 25.20; confidence interval not reported). Adherence was not significant, with no effect size reported.
The authors note extreme heterogeneity for uptake and adherence (I2 > 88%). Safety outcomes, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported. Funding and conflicts of interest were not reported. The analysis is based on observational and community-based data, so associations cannot be interpreted as causal.
Practice relevance suggested by the authors is that policy should support differentiated, hybrid models combining community-based engagement with streamlined telehealth or pharmacy-led pathways, tailored to local context. Given the non-significant uptake and adherence findings and extreme heterogeneity, these results should be viewed as hypothesis-generating rather than definitive.
How this fits prior evidence
This meta-analysis extends prior coverage on PrEP interest and delivery. It aligns with the finding that absolute risk framing increases PrEP interest by 13.8%, suggesting communication strategies may influence willingness. It also relates to group support models that may improve PrEP uptake and adherence for adolescent girls and young women, though this analysis focuses on MSM and reports non-significant uptake and adherence overall. The telehealth subgroup finding for uptake contrasts with the overall null result and with prior coverage showing health insurance navigation did not significantly improve linkage to care. The high willingness and risk behavior changes echo prior observations of higher PrEP awareness and use among gay men compared with bisexual men.
This review looked at how community based delivery methods affect the use of PrEP, a medication used to prevent HIV. The study focused on men who have sex with men. The researchers found that when PrEP is offered through community based programs, people are much more likely to be willing to take the medication. There was also a noted increase in positive changes to risk behaviors among those in these programs.
While the results for willingness were strong, the findings for actual medication uptake and long term adherence were less clear. The data for uptake was only significant in a specific group using telehealth. Because the data for uptake and adherence were very varied across different settings, it is hard to say exactly how effective these programs are for everyone.
These results suggest that community programs can be helpful for reaching people. However, because the evidence for consistent use is still limited and varied, these findings are not yet enough to change standard medical practices. Patients should talk to their healthcare provider to find the best way to access and stay on PrEP.
What this means for you:
Community based programs increase willingness to take PrEP, but results for consistent use are still mixed.
Common questions
Does community based delivery make people more willing to take PrEP?
Yes, the study found that community based delivery significantly increased willingness to take PrEP. The data showed a high odds ratio of 5.12 for increased willingness. This suggests that meeting people in community settings can be an effective way to encourage people to consider HIV prevention medication.
Does community based delivery improve health behaviors?
The study found that community based delivery was linked to an increase in positive risk behavior changes. This means that people in these programs showed more favorable behaviors related to their health. However, the results for actual medication uptake and long term adherence were not statistically significant across most groups.
Is it more effective to get PrEP through telehealth?
The study found that uptake was only significantly higher in the specific subgroup that used telehealth. For other community based methods, the results for uptake were not significant. Because the data was very varied, you should talk to a doctor to see which delivery method is best for your specific needs.
Pre-exposure prophylaxis (PrEP) is a critical HIV prevention tool for men who have sex with men (MSM), used throughout as an inclusive umbrella term encompassing gay, bisexual, and other men who have sex with men (GBMSM). Yet, the global effectiveness of community-based delivery models across the prevention cascade remains unclear. This systematic review and meta-analysis (Prospero registered: CRD420261382434) provides a comprehensive global synthesis of community-based PrEP delivery for MSM. Following PRISMA guidelines, six databases were searched (2015–2023), and random-effects models were used to pool Odds Ratios from 21 studies. Community-based models significantly increased PrEP willingness (OR = 5.12, 95% CI: 4.30–6.10) and positive risk behavior changes (OR = 1.61, 95% CI: 1.33–1.96); however, pooled effects for uptake and adherence were non-significant with extreme heterogeneity (i2 > 88%). Critically, subgroup analyses revealed that effectiveness is not monolithic but context-dependent: telehealth models were exceptionally effective for uptake (OR = 25.20), and outcomes varied significantly by region and study design. Policy should support differentiated, hybrid models that combine community-based engagement with streamlined telehealth or pharmacy-led pathways, tailored to the local context.
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261382434, Identifier CRD420261382434.
