Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care

Abstract

ObjectiveStrategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care.MethodIndividuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment.ResultsThe majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07–2.66, P = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation.ConclusionsOur study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals’ retention in care.

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.…”

“…Canada, Scotland and Belgium) had additional behavioral criteria speci ed for MSM [23,27,38], which were largely absent in records from sub-Saharan Africa [25,28,32,37]. Despite their focus on people at high risk of HIV, eight reports mentioned uptake of PrEP was mainly among MSM [22,25,26,29,[32][33][34][35].…”

“…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].…”