Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

Abstract

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

How Do Family Physicians Perceive Their Role in Providing Pre-exposure Prophylaxis for HIV Prevention?–An Online Qualitative Study in Flanders, Belgium

“…Additional resources and practical re-organization, such as task-shifting of time-intensive PrEP counseling activities to nurse practitioners, might offer a more structural approach to facilitating PrEP implementation in primary care ( 49 ). This fits within the current attempts to strengthen the capacity of primary health care in Belgium, for instance by enabling FPs to include nurses in a multidisciplinary primary care practice.…”

Perceptions, motivations, and beliefs about HIV risk and pre-exposure prophylaxis (PrEP) among participants in a nurse-led PrEP service (PrEP-RN)

“…Clinical information included, demographic information, reason for referral, HIV and serum creatine monitoring, sexually transmitted infection diagnosis during PrEP care, mental health assessment, and length of duration in care. (See O’Byrne et al, 2019 and 2020 for more information) [ 22 , 24 ]. Interview recruitment occurred from August 2018 to March 2020 among participants who attended PrEP-RN services.…”

Nurse-led safer opioid supply and HIV pre-exposure prophylaxis: a novel pilot project

“…As detailed elsewhere, 20 – 22 PrEP-RN was a two-part nurse-led PrEP program, which comprised the following: (1) active-offer PrEP referrals by public health nurses and (2) a PrEP clinic within our sexually transmitted infection (STI) clinic. While anyone in our city could request and obtain PrEP through primary care or other PrEP clinics, PrEP-RN was designed to facilitate rapid PrEP initiation for persons at elevated risk for HIV acquisition.…”

“…These participants were 100% male, 99% gbMSM, and 54% white, with 46% reporting an income >$50,000CAD and 47% reporting having a primary care provider. 20 – 23 …”