Maintaining Access To Hiv Prep In A Pandemic: Prep-User And Health Care Professional Perspectives On A Telephone-Based Prep Service

Background To maintain access to PrEP during the COVID-19 pandemic our PrEP service (1000 PrEP-users) shifted to a largely telephone-based model (tele-PrEP). Objectives To conduct a service evaluation of tele-PrEP, exploring the views and experiences of PrEP-users and sexual health care professionals (HCPs), to understand benefits and drawbacks to inform future service delivery. Methods Parallel, web-based, anonymous surveys of PrEP-users and HCPs were developed using validated questions wherever possible. The PrEP-user survey was offered to people who had a tele-PrEP appointment between 13.11.2020–17.12.2020 and consented to participate. All HCPs conducting tele-PrEP appointments were invited to participate. Basic demographic data was captured. Data were analysed in Excel using descriptive statistics. Free text responses were thematically categorised using the Framework for a Systems Approach to Healthcare Delivery. Results Sixty-two PrEP-users and 8 HCPs completed the surveys (response rate 55% and 89% respectively). Demographic characteristics of PrEP-user respondents were broadly representative of our whole PrEP-cohort. Tele-PrEP was rated ‘excellent’ or ‘good’ by 61/62 PrEP-users, and 59/62 would recommend it to friends. PrEP-users identified convenience as a key benefit along with access to PrEP with reduced potential for COVID-19 exposure. Drawbacks were largely technological, including poor connection or issues with online booking. All HCPs felt that tele-PrEP allowed them to assess patients safely and confidently. HCPs also rated its convenience highly and felt it enabled better use of limited face-to-face clinic capacity. However, HCPs thought that tele-PrEP might create barriers for vulnerable patients, particularly those with low digital, health and/or English-language literacy. One HCP and 10/62 PrEP-users expressed a personal preference for face-to-face appointments. Conclusion Tele-PrEP is feasible and acceptable. While most respondents rated the service highly, others identified a need/preference for face-to-face appointments. Therefore, our service will continue tele-PrEP whilst ensuring availability of face-to-face care for those who require or request it.