Improving awareness and uptake of pre-exposure HIV prophylaxis (PrEP) amongst service users accessing an online postal sexually transmitted infection (STI) testing health service (e-service) in London

Introduction

PrEP was nationally commissioned in Autumn 2020. Awareness and uptake has been suboptimal in certain at-risk groups. A London e-service incorporated online questions to identify and signpost service users that may be eligible for PrEP. The effectiveness of these prompts was evaluated in returning users.

Methods

Demographics and online consultation (triage) responses were collected from e-service users who ordered a STI kit between 1.7.21- 31.10.22 and whose triage responses prompted PrEP signposting advice. Triage prompts are shown: Figure 1.

Results

426,149 unique users requested at least one STI test kit during the study period, completing 803,716 triages in total. 16% (69,867/426,149) of unique users and 12% (94,411/803,716) of triages received PrEP signposting. These users were gay/bisexual men (GBMSM) 41.0% (29441/69867), heterosexual males 16.3% (11705/69867), heterosexual females 33.1% (23768/69867), and of white British ethnicity 39.6% (27634/69867). Of users that received PrEP signposting, 50.4% (35,190/69,867) ordered a subsequent kit, during which 10.0% (3510/35190) reported taking PrEP. Of those that denied taking PrEP, 59% (18702/31680) triggered PrEP signposting again. New PrEP starters were GBMSM 95.4% (6562/6874), heterosexual male/females 1.4% (97/6874) , and of white British ethnicity 2901/6874, 42.1%. Unique users within the general testing population that reported taking PrEP increased by 38.3% from 2723/45276 (6.0%) in the month of July 2021 to 4254/50987 (8.3%) in October 2022.

Discussion

12% e-service users were considered eligible for PrEP, of whom 59% were from non-GBMSM populations. Only 10% of signposted individuals had started taking PrEP by a subsequent visit. PrEP starters were invariably GBMSM. The majority of non-starters continued to trigger PrEP signposting. Rates of PrEP use amongst e-SHS users increased by >38% between 2021 and 2022. The e-SHS signposting advice may have contributed to raising awareness and uptake of PrEP in some e-SHS users but further efforts are required to enhance uptake further, particularly among under-represented groups.