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Changing the model of HIV PrEP delivery – nurse-led telehealth in a metropolitan sexual health service: a retrospective analysis

Jewel Wai , Arthur Wong , Natalie Ovington, Paul Robinson, Rick Varma

Abstract

Background Innovative models in HIV pre-exposure prophylaxis(PrEP)delivery are required to reduce the burden on clinical services and provide convenience and access for clients. A nurse-led telehealth PrEP clinic(“TelePrEP”)with multi-modal testing pathway has been developed at Sydney Sexual Health Centre(SSHC). These include a[TEST](in-person peer-led community-based testing),Xpress(in-person nurse-led clinic-based rapid testing),and the novel MyCheck(online testing platform allowing clients to test via local pathology providers). Aim The objective of this study is to describe a nurse-led TelePrEP model of HIV PrEP delivery with multi-modal testing pathway that may be relevant to other sexual health services seeking to implement similar programs. Methods We conducted a retrospective electronic medical record review of TelePrEP consultations at SSHC. The primary outcomes were demographic and behavioural characteristics,rates of attendance of TelePrEP appointments and follow-up screening,and rates of PrEP initiation,re-initiation and continuation. The secondary outcomes were length of time from screening to TelePrEP appointment,duration of TelePrEP appointments,adherence to guideline-indicated laboratory testing,and rates of HIV/STI identified through screening. We compared outcomes between the three screening pathways and by Medicare status. Results Between August2022-June2023,472 clients were reviewed. The majority were cis-gender male(99%),non-Medicare(77%),and overseas-born(86%). Out of 610 booked TelePrEP appointments,82% attended. There was no statistically significant difference in attendance rates between the three screening pathways. 47%of the appointments resulted in PrEP initiation or re-initiation and 53%in PrEP continuation. The majority of appointments referred through MyCheck(82%)resulted in PrEP continuation. 36%attended follow-up screening,with the highest follow up occurring through clients that were referred through a[TEST](44%),and lowest through Xpress(22%). There was a larger percentage of non-Medicare clients(38%)attending follow-up screening in comparison to Medicare clients(27%). The median time from screening to TelePrEP appointment was 7days. The median duration of TelePrEP appointments was 12minutes. There was high adherence to national guidelines for testing. Screening identified 2new HIV diagnoses which were both linked into care within a week of diagnosis. Conclusion Our experience demonstrates the feasibility of a nurse-led TelePrEP model overcoming issues of accessibility for key population groups including overseas-born-MSM. Additionally, we were able to achieve high overall attendance rates,high adherence to guideline-indicated laboratory monitoring and rapid linkage to treatment for clients with HIV identified on screening.

SH24081  Accepted 13 March 2025

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