Maintaining access to HIV pre-exposure prophylaxis in a pandemic: A service evaluation of telephone-based pre-exposure prophylaxis provision

Henderson, Lindsay; Gibbs, Jo; Quinn, Jacqueline; Ramasami, Sharmini; Estcourt, Claudia

doi:10.1177/09564624211068766

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…However, a Cochrane review of improving adherence to and continuation of hormonal contraception, which might better approximate PrEP as it relates to prevention rather than treatment, provided less overlap in findings. For example, intensive counselling and reminders may result in only a slight increase in continuation of hormonal contraception although the effect varied by contraception method [45]. However, to date, interventional studies based on published recommendations, and designed to overcome barriers to improve PrEP adherence and retention specifically, are lacking and robust evaluation of the impact of these approaches is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Within the UK context, sexual health service delivery has changed significantly during the SAR-CoV2 pandemic with face-to-face appointments being reserved for people who are symptomatic and or have more complex needs. PrEP services have largely shifted to telephone models [46]. The opportunity to deliver some of our recommendations may be more challenging should services continue with more remote and light-touch models of care but are no less important.…”

Section: Implications For Policy and Practicementioning

confidence: 99%

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Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Recommendation development from a national PrEP programme

MacDonald

Estcourt

Flowers

et al. 2022

Preprint

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Introduction: HIV pre-exposure prophylaxis (PrEP) is a key component of HIV combination prevention. Effective prevention needs people to adhere to PrEP during periods of risk and remain in care. However, relevant models of care are under-researched. Using data from the first two years of Scotlands PrEP programme, we explored barriers and facilitators to PrEP adherence and retention in care and systematically developed evidence-based, theoretically-informed recommendations to enhance future adherence and retention. Methods: We conducted semi-structured interviews and focus groups (09/2018-07/2019) with geographically and demographically diverse patients who were either using/declined/stopped or had been assessed as ineligible for PrEP (n=39), healthcare professionals involved in PrEP provision (n= 54), non-governmental organisation service users (n=9) and staff (n=15) across Scotland. We used thematic analysis to map key barriers and facilitators to priority areas that could enhance adherence and retention in care. Next, we used analytic tools from implementation science (Theoretical Domains Framework, Intervention Functions, Behaviour Change Technique Taxonomy, APEASE criteria) and expert opinion to systematically generate recommendations to enhance future PrEP adherence and retention in care. Results: Barriers and facilitators to adherence and retention in care were diverse and multi-layered. Barriers included perceived complexity of event-based dosing, the tendency for users to stop PrEP before seeking professional support, troublesome side-effects, limited flexibility in the settings, timings, and nature of appointments for follow up, enduring PrEP-related stigma and emerging stigmas around not using PrEP. Facilitators included flexible appointment scheduling, reminders, and processes to follow up non-attenders. We generated 25 wide-ranging but specific recommendations for key stakeholders, for example, emphasising the benefits of PrEP reviews and providing appointments flexibly within individualised PrEP care; using clinic systems to remind/recall PrEP users for review; supporting PrEP conversations among sexual partners; clear guidance on event-based dosing; encouraging/commitment to good PrEP citizenship; and detailed discussion on managing side-effects and care/coping planning activities. Conclusions: PrEP adherence and retention in care is challenging for many people. Such challenges reduce the benefits of PrEP at individual and population levels. Our findings identify and provide solutions to where and how collaborative interventions across public health, clinical, and community practice could address these challenges.

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Section: Discussionmentioning

confidence: 99%

Section: Implications For Policy and Practicementioning

confidence: 99%

Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Recommendation development from a national PrEP programme

MacDonald

Estcourt

Flowers

et al. 2022

Preprint

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“…Where evaluated, these changes have been found to be acceptable, although not always preferable to service users. [18][19][20] The rapid transition to online and telehealth services during the COVID-19 pandemic has highlighted the potential and the limitations of these approaches, and the risk of digital exclusion of vulnerable people. 21 However, hybrid approaches to telehealth and face-to-face service delivery, increasing decentralisation and the growth of digital services is likely to continue.…”

Section: Are New Models Enough?mentioning

confidence: 99%

Why sexual health clinics are important in the 2020s

Medland

Taylor²,

Saunders³

et al. 2022

Sex. Health

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To make services more accessible, acceptable and affordable, sexual health service delivery models have embraced innovation, technology, outreach and decentralisation. In particular, some routine high-volume services, like asymptomatic testing for sexually transmitted infections (STIs), can be delivered in general practice, online or in non-clinical settings. On the surface, sexual health clinics, like hospitals or other primary care clinics, might appear to be operating on a model that has not changed significantly in recent times. However, globally sexual healthcare needs are rising both in volume and complexity, not all of which can be adequately met through decentralised care. Sexual health clinics themselves are the site of considerable innovation. The importance of sexual health clinics in the diagnosis and treatment of symptomatic STIs is likely to increase with the increasing burden of disease, the complexity of treatment guidelines and the emergence of new infections. Services essential to patient health such as immediate or complex clinical care, partner notification and safeguarding, and activities essential to the health system like research, training and supervision require expertise to be located where it can be accessed and maintained at reasonable cost. We do not know whether increasing some services outside existing models can safely compensate for reducing other services inside them.

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“…(7) Actualmente existen numerosas estrategias de telesalud y teleeducación que están dirigidas a estimular el uso de PrEP. (5,6,8,9,10,11,12) Chile en el año 2019 implementó el PrEP y su adquisición actual es presencial. (13) Desde su implementación se ha evidenciado baja adherencia.…”

Section: Desarrollounclassified

Pre-Exposure Prophylaxis and new technologies for treatment adherence in Chile

Silva-Sánchez¹,

Reynaldos-Grandón²

2022

Salud, Ciencia y Tecnología

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Apoyado en el informe del “Programa de las Naciones Unidas en VIH/SIDA del 2019” y la baja adherencia a la profilaxis pre-exposición sexual (PrEP) en las poblaciones de riesgo en Chile desde su implementación en el año 2019, se presenta una reflexión sobre los beneficios que tienen actualmente las nuevas tecnologías como la telemedicina y como ésta influye en el acceso y la adherencia a la terapia, de acuerdo con algunas de las estrategias tecnológicas actuales implementadas en Estados Unidos. En contraste, si bien Chile plantea lineamientos de telemedicina y telesalud, estos no están dirigidos a la mejorar el acceso a la terapia en los grupos de riesgo. Se propone que extender los servicios de telemedicina a aquellas personas que requieran de PrEP podrían ser beneficioso para aumentar la adherencia y acceso, además de disminuir los contagios de VIH. Asimismo, otros países de la región pueden adscribirse a estas innovaciones en busca del mismo objetivo-meta

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Maintaining access to HIV pre-exposure prophylaxis in a pandemic: A service evaluation of telephone-based pre-exposure prophylaxis provision

Cited by 10 publications

References 10 publications

Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Recommendation development from a national PrEP programme

Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Recommendation development from a national PrEP programme

Why sexual health clinics are important in the 2020s

Pre-Exposure Prophylaxis and new technologies for treatment adherence in Chile

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