Evolution of a pre-exposure prophylaxis (PrEP) service in a community-located sexual health clinic: concise report of the PrEPxpress

Abstract

Screening and treatment of sexually transmissible infections, including HIV, are free in the UK nations; pre-exposure prophylaxis (PrEP) became free in England in October 2017 through the PrEP Impact trial. Doctor-led PrEP clinics started at 56 Dean Street in September 2015, with the drug purchased privately at full price. The service was expanded to other staff to support initiation and monitoring of increasing numbers of attendees purchasing PrEP from online pharmacies. Nonetheless, when the clinic was given a target of 1700 for the PrEP Impact trial, it was clear this could not be achieved in a timely manner through 56 Dean Street alone. To prepare for the trial, all staff with HIV testing competencies were trained in good clinical practice and trial-specific procedures, and a patient group directive was approved to facilitate nurse prescribing and dispensing. Electronic pro formas to capture eligibility for starting or continuing PrEP were adapted for the Dean Street Express clinic, with some information collected directly from service users using touch screens. These interventions, together with an update to the 2016 information leaflet developed by the community, enabled enrolment and follow-up of 1700 participants in 4 months. PrEP advice and monitoring were easily accommodated in the 56 Dean Street sexual health service, but did require additional training and approval for nurse prescribing and dispensing drug in order to achieve the target, which still fell short of the demand.

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“…Seventeen articles focused on people at high risk of HIV acquisition without targeting a speci c group [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Yet the description of people at risk of HIV in these records was often based upon differing criteria of eligibility.…”

“…The majority of all articles (n = 19) mentioned PrEP services were available in specialised STI, HIV and/or sexual health clinics. The sta ng of these clinics differed, yet was reportedly often nurse-led [24,25,29,31,34,38,40]. In high-resource settings, PrEP was more likely to be delivered in such specialised clinics, in particular in USA, Belgium, Scotland, England, Australia, New Zealand and Canada [22,23,24,27,29,31,34,38,40].…”

“…The sta ng of these clinics differed, yet was reportedly often nurse-led [24,25,29,31,34,38,40]. In high-resource settings, PrEP was more likely to be delivered in such specialised clinics, in particular in USA, Belgium, Scotland, England, Australia, New Zealand and Canada [22,23,24,27,29,31,34,38,40]. In reports from Kenya, Zimbabwe and Table 1 (see end of manuscript) should be positioned here in the main text South Africa, specialised clinics were mentioned as part of the existing facilities used to scale-up the provision of PrEP [25,28,32,37,52].…”

“…In these models nurses were pivotal providers of PrEP-related services, with physicians consulted for 'complex cases' [24,25,29,31,34,38,40,51,53,54]. The feasibility of a nurse-led approach was con rmed in different settings, from STI clinics to CHCs [24,29,31,34,38,40]. The authors explained how such task-shifting strategy could be more cost-effective and allowed for decentralised care [38,54].…”

“…Delivery channels were understood as platforms or media that were used to deliver PrEP services to the people. In most of the articles, PrEP care was provided through a 'traditional' face-to-face setting, meaning PrEP clients attended in-person to a service provider in a given physical setting [22][23][24][25][26][27][28][29][31][32][33][34][35][36][37][38]40,44,47,[49][50][51][52][53][54].…”