Effects of Telehealth on Hiv Pre-Exposure Prophylaxis: A Systematic Review

HIV pre-exposure prophylaxis (PrEP) is an effective and safe prevention strategy, particularly among key populations such as men who have sex with men (MSM) and transgender women. However, barriers such as stigma, geographic access, and costs limit its adoption. Telemedicine has emerged as an alternative to expand access, reduce disparities, and improve adherence among target populations. This study synthesizes evidence from randomized clinical trials (RCTs) on the efficacy of telemedicine in PrEP delivery, comparing it with in-person models. This systematic review and meta-analysis evaluated the efficacy of telemedicine compared with traditional PrEP delivery models, following PRISMA 2020 guidelines and a PICO strategy, with the protocol registered in PROSPERO (CRD: CRD42025642948). The databases PubMed, LILACS, and SciELO were searched. RCTs in English, Portuguese, Spanish, or French (2019–2024). double-blind screening and standardized data extraction. Telemedicine demonstrated greater efficacy than conventional PrEP models, with a relative risk (RR) of 1.44 95% CI: 1.18–1.76 for adherence/initiation, according to meta-analysis of three RCTs (n = 1,458). Moderate heterogeneity (I² = 67%, p = 0.048) reflected intervention differences: platforms with digital reminders and remote consultations (PrEPTECH-USA, Jichunge-Tanzania) showed greater impact than passive models. In the United States, TelePrEP increased initiation 2.4-fold (64.2% vs. 27.3%) with no advantage for prolonged adherence (17.8 vs. 19.7 days/month). In Tanzania, the Jichunge app improved early retention (29.4% vs. 17.7%), although 70% discontinued within 30 days. In contrast, in China, WeChat reminders enhanced identification of low adherence, outperforming non-notification TelePrEP models by 28% in early adherence. Finally, interventions including active components (e.g., reminders, virtual consultations) achieved 1.5-fold better outcomes than basic TelePrEP. Telemedicine emerges as a promising strategy to democratize PrEP access, especially among vulnerable populations. Programs such as Combine! in Brazil (Grangeiro et al., 2023) and Iowa TelePrEP validate its integration into public health systems, reducing costs and expanding coverage. However, maintaining adherence requires combined interventions, including psychosocial support via apps and hybrid in-person/virtual follow-ups.