Abstract

Human immunodeficiency virus (HIV) remains a significant public health challenge in sub-Saharan Africa, where 
the region continued to account for nearly two-thirds of the global disease burden. Although antiretroviral therapy 
had transformed outcomes, the incidence of new infections remains high, particularly among adolescents, young 
women, men who have sex with men, and key vulnerable populations. The use of antiretroviral drugs by HIV
negative individuals at risk, has emerged as a cornerstone prevention strategy. The purpose of this review was to 
evaluate community-based approaches to PrEP implementation in sub-Saharan Africa, focusing on access, adherence, 
pharmacological efficacy, and programmatic outcomes. This review was composed through a systematic search of 
PubMed, Scopus, and Web of Science for articles published between 2012 and 2025, restricted to English-language 
studies conducted in sub-Saharan Africa or global studies with regional relevance, synthesizing evidence narratively. 
Findings indicated that community-led distribution, task-shifting to non-specialist providers, integration with 
sexual and reproductive health services, and digital adherence tools improve PrEP uptake and retention. 
Pharmacokinetic studies demonstrated that daily oral tenofovir disoproxil fumarate with emtricitabine achieves 
protective intracellular tenofovir diphosphate concentrations with steady-state levels reached after seven daily doses, 
while long-acting injectable cabotegravir shows favorable half-life (t1/2 ~40 days) and superior adherence outcomes. 
Nonetheless, barriers included stigma, inconsistent supply chains, and insufficient youth-targeted interventions. 
Effective community-based strategies reduce HIV incidence and support UNAIDS 95-95-95 targets. Future 
programs must combine biomedical efficacy with locally tailored social and structural enablers. 
Keywords: HIV prevention, PrEP, Sub-Saharan Africa, Community-based intervention, Adherence.