Setting the stage for expanding HIV pre-exposure prophylaxis use in Canada

Hull, Mark; Dhs, Tan

doi:10.14745/ccdr.v43i12a05

Cited by 18 publications

(13 citation statements)

References 34 publications

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“…In most settings in Canada, PrEP is prescribed primarily by HIV or sexual health specialists, however there are no restrictions for general practitioners to prescribe PrEP 13. Public reimbursement of PrEP varies provincially across Canada.…”

Section: Introductionmentioning

confidence: 99%

“…In Quebec, TDF-FTC is reimbursable through the provincial drug plan without restriction by HIV status, thereby permitting off-label dispensing to PrEP users since 2013 with a monthly copayment ($80–90 CAD) or via private insurance. Elsewhere in Canada, TDF-FTC for use as PrEP was not reimbursable until after 2017,13 and therefore was largely inaccessible due to prohibitive out-of-pocket costs ranging from $800 to 1000 CAD for a monthly course of daily PrEP 14. This issue of cost as a barrier to PrEP access was addressed in a 2016 report by the Canadian Drug Expert Committee of the Canadian Agency for Drugs and Technologies in Health recommending that the cost of PrEP be subsidised by public drug plans in Canada 15…”

Section: Introductionmentioning

confidence: 99%

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Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

Greenwald¹,

Maheu‐Giroux

Szabo³

et al. 2019

BMJ Open

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PurposeThel’Actuel PrEP Cohortwas established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l’Actuel, a large sexual health clinic located in Montreal, Canada.ParticipantsSince the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. Thel’Actuel PrEP Cohortcontains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America.Findings to dateNo incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start.Future plansThel’Actuel PrEP Cohortcontinues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

Greenwald¹,

Maheu‐Giroux

Szabo³

et al. 2019

BMJ Open

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“… 2 Several experts have recognized that the end of the HIV epidemic would need to include prescription of PrEP by a wider range of health care providers. 6 , 29–32 …”

Section: Discussionmentioning

confidence: 99%

Attitudes and Practices of a Sample of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis

Sinno¹,

Doria²,

Cochkanoff³

et al. 2021

HIV

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Introduction Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that requires the ongoing support of physicians to be accessible. Recently, Nova Scotia experienced a 100% increase in HIV diagnoses. The purpose of this study is to explore the relationship between physicians’ support of PrEP, knowledge of PrEP, and PrEP prescribing history using the information-motivation-behavioral (IMB) skills model. Methods An online survey was distributed to physicians in Nova Scotia, Canada, and eighty physicians participated. Two exploratory factor analyses were conducted with items from the Support of PrEP scale and Knowledge of PrEP scale. A mediation analysis was conducted to assess if knowledge of PrEP mediated the relationship between support of PrEP and whether physicians have prescribed PrEP in the past. Results On average, physicians reported strong support for PrEP, and as support for PrEP increased so did knowledge of PrEP. Further, physicians who had prescribed PrEP demonstrated strong knowledge of PrEP and physicians who had not prescribed PrEP reported feeling neutral. The 95% bootstrap confidence interval indirect effect of Support for PrEP on prescription history did not include zero (B = 1.59, 95% BsCI [0.83, 3.57]) demonstrating that the effect of support for PrEP is mediated by knowledge of PrEP. The most commonly identified barrier to prescribing PrEP was the lack of drug coverage among patients. Conclusion The results of the mediation analysis support the IMB skills model regarding support for PrEP, Knowledge of PrEP, and having prescribed PrEP in the past. Our findings suggest that to improve PrEP uptake in Nova Scotia, educational interventions for physicians and universal coverage of the drug would be necessary.

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“…26 However, surveys have shown that providers feel that it lies within their scope of practice, and that primary care is an appropriate setting for this aspect of HIV care. 27–29 A study done using a Project ECHO telehealth program to deliver PrEP education showed that providers reported improved knowledge about, and increased likelihood of providing, PrEP. 30…”

Section: Discussionmentioning

confidence: 99%

Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

Kendall

Porter

Shoemaker

et al. 2019

MDM Policy & Practice

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Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

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Setting the stage for expanding HIV pre-exposure prophylaxis use in Canada

Cited by 18 publications

References 34 publications

Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

Attitudes and Practices of a Sample of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis

Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

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