{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:25:50Z","timestamp":1789046750334,"version":"build-2803163510"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    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\u20132023), and random-effects models were used to pool Odds Ratios from 21 studies. Community-based models significantly increased PrEP willingness (OR\u202f=\u202f5.12, 95% CI: 4.30\u20136.10) and positive risk behavior changes (OR\u202f=\u202f1.61, 95% CI: 1.33\u20131.96); however, pooled effects for uptake and adherence were non-significant with extreme heterogeneity (\n                    <jats:italic>i<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    &amp;gt;\u202f88%). Critically, subgroup analyses revealed that effectiveness is not monolithic but context-dependent: telehealth models were exceptionally effective for uptake (OR\u202f=\u202f25.20), 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.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261382434<\/jats:ext-link>\n                      , Identifier CRD420261382434.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1868507","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:28:26Z","timestamp":1789043306000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of community-based PrEP delivery for men who have sex with men: a global systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Abeer","family":"Teeti","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam","family":"AbuQeis","sequence":"additional","affiliation":[{"name":"School of Basic Medicine, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Wang","sequence":"additional","affiliation":[{"name":"Yunnan International Joint Laboratory of Public Health and Disease Control, Yunnan Center for Disease Control and Prevention (Yunnan Academy of Preventive Medicine)","place":["Kunming, Yunnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1097\/01.aids.0000390087.22565.b4","article-title":"A review of the epidemiology of HIV infection and prevention responses among MSM in Asia","volume":"24","author":"van Griensven","year":"2010","journal-title":"AIDS"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1097\/01.aids.0000432449.30239.fe","article-title":"The increase in global HIV epidemics in MSM","volume":"27","author":"Beyrer","year":"2013","journal-title":"AIDS"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/s1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study","volume":"14","author":"Grant","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e486","DOI":"10.1016\/s2352-3018(21)00074-6","article-title":"Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study","volume":"8","author":"Grulich","year":"2021","journal-title":"Lancet HIV"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e402","DOI":"10.1016\/s2352-3018(17)30089-9","article-title":"Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study","volume":"4","author":"Molina","year":"2017","journal-title":"Lancet HIV"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/s0140-6736(15)00056-2","article-title":"Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"387","author":"McCormack","year":"2016","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1097\/qai.0000000000000172","article-title":"HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention","volume":"66","author":"Donnell","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1089\/apc.2012.0419","article-title":"From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in new York City","volume":"27","author":"Golub","year":"2013","journal-title":"AIDS Patient Care STDs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1186\/s12913-021-06920-4","article-title":"A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa","volume":"21","author":"Rousseau","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"17455057221091727","DOI":"10.1177\/17455057221091727","article-title":"'We go where we know': reflections from mobilizing for PrEP and sexual health (MobPrESH)\u2014a peer-led PrEP education programme across England, for and by women and non-binary people","volume":"18","author":"Grenfell","year":"2022","journal-title":"Womens Health (Lond)"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e12916","DOI":"10.1111\/jrh.12916","article-title":"Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: a scoping review framed by the PrEP care continuum","volume":"41","author":"O'Neil","year":"2025","journal-title":"J Rural Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s43058-021-00148-3","article-title":"Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis","volume":"2","author":"Piper","year":"2021","journal-title":"Implement Sci Commun"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12981-022-00456-1","article-title":"Evidence and implication of interventions across various socioecological levels to address pre-exposure prophylaxis uptake and adherence among men who have sex with men in the United States: a systematic review","volume":"19","author":"Wang","year":"2022","journal-title":"AIDS Res Ther"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"102647","DOI":"10.1016\/j.eclinm.2024.102647","article-title":"Restarting pre-exposure prophylaxis (PrEP) for HIV: a systematic review and meta-analysis","volume":"72","author":"Kiggundu","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1080\/09540121.2021.1871721","article-title":"\"belt and braces approach; added benefit and\u202f\u2026\u202fextra reassurance\": a multi-stakeholder examination of the challenges to effective provision of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in northern and Central England","volume":"33","author":"Hillis","year":"2021","journal-title":"AIDS Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"20527","DOI":"10.7448\/ias.18.4.20527","article-title":"PrEP implementation science: state-of-the-art and research agenda","volume":"18","author":"C\u00e1ceres","year":"2015","journal-title":"J Int AIDS Soc"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1056\/NEJMoa2101016","article-title":"Cabotegravir for HIV prevention in cisgender men and transgender women","volume":"385","author":"Landovitz","year":"2021","journal-title":"N Engl J Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/s0140-6736(20)31065-5","article-title":"Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial","volume":"396","author":"Mayer","year":"2020","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1097\/qad.0000000000001385","article-title":"Defining the HIV pre-exposure prophylaxis care continuum","volume":"31","author":"Nunn","year":"2017","journal-title":"AIDS"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2020","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e277","DOI":"10.1016\/s2352-3018(18)30044-4","article-title":"Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis","volume":"5","author":"Figueroa","year":"2018","journal-title":"Lancet HIV"},{"key":"ref22","first-page":"180","article-title":"JBI critical appraisal checklist for systematic reviews and research syntheses","volume":"45","author":"M","year":"2024","journal-title":"J Can Health Libr Assoc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref24","article-title":"National Heart, Lung, and Blood Institute (NIH)","volume-title":"Study Quality Assessment Tools","year":"2021"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1016\/s2352-3018(24)00295-9","article-title":"Costs and outcomes of routine HIV oral pre-exposure prophylaxis implementation across different service delivery models and key populations in South Africa: a retrospective cohort study","volume":"12","author":"Hendrickson","year":"2025","journal-title":"Lancet HIV"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e0182838","DOI":"10.1371\/journal.pone.0182838","article-title":"Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: findings from an online survey","volume":"12","author":"Lim","year":"2017","journal-title":"PLoS One"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1111\/tmi.13129","article-title":"Interest in HIV pre-exposure prophylaxis in men who have sex with men in West Africa (CohMSM ANRS 12324\u2014expertise France)","volume":"23","author":"Coulaud","year":"2018","journal-title":"Trop Med Int Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1007\/s10508-019-01620-x","article-title":"PrEP interest among men who have sex with men in the Netherlands: covariates and differences across samples","volume":"49","author":"van Dijk","year":"2020","journal-title":"Arch Sex Behav"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1080\/09540121.2023.2268887","article-title":"When awareness is not a barrier to PrEP uptake among men who have sex with men who are eligible for PrEP in France","volume":"36","author":"Di Ciaccio","year":"2024","journal-title":"AIDS Care"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e053634","DOI":"10.1136\/bmjopen-2021-053634","article-title":"Willingness, preferred ways and potential barriers to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in China","volume":"11","author":"Yu","year":"2021","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1007\/s10461-017-2009-x","article-title":"HIV pre-exposure prophylaxis (PrEP) uptake and retention among men who have sex with men in a community-based sexual health clinic","volume":"22","author":"Hojilla","year":"2018","journal-title":"AIDS Behav"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1007\/s40615-021-01154-w","article-title":"Intersecting communities and PrEP uptake among US-based Latinx sexual minority men","volume":"9","author":"Robles","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"113","DOI":"10.5582\/bst.2016.01035","article-title":"Low willingness and actual uptake of pre-exposure prophylaxis for HIV-1 prevention among men who have sex with men in Shanghai, China","volume":"10","author":"Ding","year":"2016","journal-title":"Biosci Trends"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e420","DOI":"10.1016\/s2352-3018(21)00005-9","article-title":"HIV pre-exposure prophylaxis for men who have sex with men in West Africa: a multicountry demonstration study","volume":"8","author":"Laurent","year":"2021","journal-title":"Lancet HIV"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e25223","DOI":"10.1002\/jia2.25223","article-title":"Pre-exposure prophylaxis initiation and adherence among black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study","volume":"22","author":"Wheeler","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/qai.0000000000003375","article-title":"Effectiveness of PrEPTECH: findings from a 180-day randomized controlled trial of a pre-exposure prophylaxis telehealth intervention","volume":"95","author":"Erenrich","year":"2024","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"3974","DOI":"10.1186\/s12889-025-25232-4","article-title":"Transition from HIV post-exposure prophylaxis to pre-exposure prophylaxis and awareness-to-use cascade among men who have sex with men: a longitudinal study in Guangxi, China","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Public Health"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25564","article-title":"Youth-friendly services and a mobile phone application to promote adherence to pre-exposure prophylaxis among adolescent men who have sex with men and transgender women at-risk for HIV in Thailand: a randomized control trial","volume":"23","author":"Songtaweesin","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1186\/s12889-022-14211-8","article-title":"Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa","volume":"22","author":"Eubanks","year":"2022","journal-title":"BMC Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/s12889-018-5180-8","article-title":"High HIV risk and syndemic burden regardless of referral source among MSM screening for a PrEP demonstration project in Toronto, Canada","volume":"18","author":"Wilton","year":"2018","journal-title":"BMC Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e0328713","DOI":"10.1371\/journal.pone.0328713","article-title":"Development and evaluation of an online HIV pre-exposure prophylaxis (PrEP) training program for community pharmacists to implement pharmacy-led PrEP services in Malaysia","volume":"20","author":"Gan","year":"2025","journal-title":"PLoS One"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"3074","DOI":"10.1007\/s10461-021-03253-5","article-title":"Willingness to use pre-exposure prophylaxis (PrEP) and preferences among men who have sex with men in Mumbai and Chennai, India: a discrete choice experiment","volume":"25","author":"Chakrapani","year":"2021","journal-title":"AIDS Behav"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"342","DOI":"10.17269\/s41997-018-0064-3","article-title":"Trends in the awareness, acceptability, and usage of HIV pre-exposure prophylaxis among at-risk men who have sex with men in Toronto","volume":"109","author":"Rana","year":"2018","journal-title":"Can J Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1071\/sh18065","article-title":"Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand","volume":"15","author":"Phanuphak","year":"2018","journal-title":"Sex Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.ajodo.2020.04.002","article-title":"Exploring heterogeneity in meta-analysis: subgroup analysis. Part 1","volume":"158","author":"Spineli","year":"2020","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e25351","DOI":"10.1002\/jia2.25351","article-title":"Give PrEP a chance: moving on from the \"risk compensation\" concept","volume":"22","author":"Rojas Castro","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1080\/00224499.2021.1936440","article-title":"How has HIV pre-exposure prophylaxis (PrEP) changed sex? A review of research in a new era of bio-behavioral HIV prevention","volume":"58","author":"Grov","year":"2021","journal-title":"J Sex Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"2875","DOI":"10.1007\/s10461-024-04366-3","article-title":"Telehealth models for PrEP delivery: a systematic review of acceptability, implementation, and impact on the PrEP care continuum in the United States","volume":"28","author":"Bonett","year":"2024","journal-title":"AIDS Behav"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e0289353","DOI":"10.1371\/journal.pone.0289353","article-title":"PrEP uptake and early persistence among adolescent girls and young women receiving services via community and hybrid community-clinic models in Namibia","volume":"18","author":"Barnabee","year":"2023","journal-title":"PLoS One"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868507\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:28:28Z","timestamp":1789043308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1868507\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2026.1868507"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1868507","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1868507"}}