PrEP Initiation, Continuation Feasible in Range of Clinical Settings

Initiation, monitoring, and continuation of pre-exposure prophylaxis (PrEP) was found to be feasible in a variety of clinical settings through a range of providers after the implementation of a provincial program in Alberta, Canada, according to the results of a study published in the Journal of the Association of Medical Microbiology and Infectious Disease.

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Investigators conducted a retrospective audit of a cohort of individuals accessing PrEP from 5 clinical sites in Alberta between March 2016 and June 2019 to determine the ability to deliver PrEP in a variety of settings and from different providers, as well as to examine the overall adherence to provincial HIV PrEP guidelines.

In October 2018, Alberta instituted universal PrEP coverage for all Alberta residents with valid Alberta Health Coverage when prescribed by a designated PrEP prescriber (DPP), the investigators explained. A DPP could be any physician or nurse practitioner who completed in-person group sessions and an online module and thereafter applied to be registered.

A total of 511 participants had records available to be analyzed during the study period, with 98.4% (503) being male and a median age of 34 years (IQR: 28-43). Further, 89.8% (459) participants reported having only men as their sexual partners, the study authors wrote.

The majority (86.9%; 444) of participants initiated PrEP after universal coverage was available in Alberta, the results of the study show. A total of 381 (74.6%) individuals had follow-up visits—with a median of 2 follow-ups—and 4.7% of the participants had more than 5 follow-ups.

Non-prescription drug use was reported by 57.8% (294) of the participants at the initial visit, whereas alcohol use was reported by 55.4% (283), according to the study results. Further, one-third of participants (37.0%; 189) had received at least 1 dose of human papillomavirus vaccination and 38.2% (195) were vaccinated against hepatitis A.

All but 1 participant met the PrEP guideline indications for sexual partners being MSM, trans women or gender diverse people, the investigators wrote. The majority (94.3%; 482) of participants reported having condomless anal sex in the past 6 months, whereas a small proportion of individuals self-reported having either CT (13.9%; 71), GC (14.5%; 74), and/or syphilis (6.8%; 35) in the prior 12-month period.

The study authors noted that not all participants reported for their second visit 1 month after initiating PrEP, and of the 511 participants at baseline, 83 (16.2%) discontinued PrEP altogether. Reasons cited included adverse effects (10; 2.0%), monogamous partner (5, 1.0%), patient no show (41, 8.0%), temporary discontinuation (18, 3.5%), and leaving the care of the prescriber (8, 1.6%).

In discussing the results, investigators noted it was not surprising that STI clinics and sexual health services were among the early adopters of PrEP delivery due to on-site expertise, yet it remains important to create a unified approach and include other providers and settings to optimize the reach of PrEP services, especially to underserved populations.

One of the major limitations of the study that the authors discussed was its retrospective design, which could potentially result in left out details, such as STIs diagnosed by other care providers, leading to an underestimate on the incidence of infection.

A further limitation was the collection of data from 3 areas in Alberta—2 urban areas and 1 semi-urban area—which could make it difficult to generalize these results to the entirety of Alberta without excluding those in rural or remote regions of the province.

“Further work is needed to evaluate the overall uptake of PrEP in Alberta to examine the program gaps and to identify opportunities for improvement,” the study authors concluded.

Reference

Candler E, Khan M N, Gratrix J, et al. Retrospective audit of a convenience cohort of individuals on HIV pre-exposure prophylaxis in Alberta, Canada. J Assoc Med Microbiol Infect Dis Can. 2022; 7(4):350-363. doi:10.3138/jammi-2022-0016