Alcohol Use and the Care Continuum for HIV Preexposure Prophylaxis: An Updated Scoping Review of Research and Interventions.

HIV preexposure prophylaxis (PrEP) effectiveness depends on engagement across the PrEP care continuum. Alcohol use may influence these steps, but findings remain inconsistent. This scoping review examined studies published since March 2020 that evaluated the association between alcohol use and PrEP outcomes and identified interventions targeting PrEP users who consume alcohol. We searched two databases, conducted citation tracking, and extracted data from studies measuring the association between alcohol use and ≥ 1 step in the PrEP care continuum. We also included intervention studies targeting alcohol use among PrEP users. Findings were combined with four previous reviews to generate an updated evidence map. We identified 55 studies, including 42 quantitative studies reporting 57 associations. Most were cross-sectional, conducted in North America, and focused on men who have sex with men. Adherence was the most frequently examined outcome, followed by uptake, continuation, willingness, and awareness. Associations between alcohol use and PrEP outcomes were mixed. Six intervention studies were identified, but none demonstrated significant improvements in PrEP outcomes. The updated evidence map includes 85 quantitative studies reporting 106 associations between alcohol use and the PrEP outcomes. The association between alcohol use and the PrEP care continuum remains mixed and likely dependent on the measure or intensity of alcohol use, context, and population characteristics. Overall, this evidence suggests the need for more effective interventions and a meta-analysis to better define alcohol's role in PrEP outcomes.