PrEP Delivery for U.S. Adolescents and Young Adults: A Systematic Review and Narrative Synthesis.

Despite proven efficacy in preventing human immunodeficiency virus (HIV) transmission, pre-exposure prophylaxis (PrEP) remains underutilized among adolescents and young adults (AYA) in the United States (US). This systematic review and narrative synthesis examined approaches for delivering PrEP to AYA aged 12-24 years. A comprehensive search of four major databases identified 10 studies meeting the predefined inclusion criteria. Across studies, successful implementation approaches were often multimodal, integrating technology, provider support, and personalized navigation. Technology-enhanced delivery strategies, particularly those using interactive messaging, were associated with improved PrEP adherence and clinic engagement, while provider-focused interventions that integrated clinical decision support systems within workflows facilitated PrEP prescribing. Personalized navigation services were consistently identified as valuable for improving engagement among marginalized AYA. The literature also revealed ongoing implementation gaps, indicating a need for coordinated, multi-level strategies to address the barriers AYA face.