Barriers and Facilitators of PrEP uptake among MSM in Europe: a systematic review and evidence synthesis using the COM-B model

Abstract

Background. After 6 years since PrEP’s approval in Europe, its uptake among eligible MSM continues to be well below the “zero transmission” targets set by the UNAIDS. This study gathers the reported motivators and barriers that influence the intention of PrEP use by eligible HIV-negative MSM in Europe. The findings are contrasted to the COM-B model, which is the core of the Behaviour Change Wheel, a theory widely used to design social interventions. The objective is to test the COM-B viability for this social key issue for potential further implementation research. Methods. A systematic search through PubMed and Scopus databases was conducted to find relevant studies published from 2016 onwards. Thematic analysis was used to fit the results into the COM-B model. Results. 191 studies found through databases were assessed for eligibility, of which 17 full text were included in the final analysis plus three additional studies from grey literature. Most findings could be categorized into the COM-B factors (psychological capability, physical capability, physical opportunity, social opportunity, reflective motivation, automatic motivation). However, some categories fell outside of the COM-B model therefore two additional factors were added (behavioural and demographic). Conclusions.The COM-B model is an effective behavioural theory to analyse this particular issue and it could be a starting point for further research on how to design theoryinformed interventions, however it is incomplete. Specific behavioural and demographic characteristics of different groups within the MSM population should be considered in intervention design.