Experiences of HIV Pre-Exposure Prophylaxis (PrEP) users in Wales during the COVID-19 pandemic – A qualitative interview study.

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

6C.6

Presenter:

Zahraa Khammas

Co-authors:

David Gillespie, Adam Williams, Jane Nicholls, Fiona Wood

Author institutions:

Ms Zahraa Khammas Cardiff University Cardiff, Dr David Gillespie Centre for Trials Research Cardiff University, Mr Adam Williams Centre for Trials Research Cardiff University, Dr Jane Nicholls Cardiff and the Vale University Health Board, Prof Fiona Wood Division of Population Medicine and PRIME Centre Wales Cardiff University

Problem

Background: HIV pre-exposure prophylaxis (PrEP) is a medication taken by HIV negative individuals to prevent HIV. It has been available in Wales since 2017. The COVID-19 pandemic impacted all aspects of social life and health services, and sexual health services in the UK saw an 80% reduction of service provision. However, research is lacking about the experiences of PrEP users during this time and how professionals working in primary and secondary care can improve sexual health advice during future pandemics.Aim: We aimed to explore the experiences of PrEP users in Wales following the introduction of COVID-19 pandemic measures, with a focus on PrEP use, PrEP access, sexual behaviours, and well-being.

Approach

Methods: We conducted a secondary analysis of interview data from two prior studies, which focussed on adherence to PrEP and the impact of PrEP on sexual behaviour. The studies collected data during the COVID-19 pandemic, between May 2020 and February 2021, using remote interviewing methods. Participants were: ≥ 18 years of age, residents in Wales, and men who have sex with men (MSM). Although the impact of COVID-19 was not the main focus of either study, many participants reflected on how the pandemic had affected their PrEP use, sexual behaviour and wellbeing. Secondary data analysis was conducted by lead author (a medical student) using reflexive thematic analysis, with support from co-authors. NVivo12 was used to support analysis.

Findings

Findings: Thirty-two interview transcripts were available, three lacked data relating to COVID-19, leaving 29 for analysis. Major themes include: 1) PrEP use during COVID-19, 2) Sexual Behaviour following COVID-19 restrictions, 3) NHS service provision during the COVID-19 pandemic. Most participants experienced a change in PrEP use (the majority paused their PrEP use, others continued as usual, and some switched to event-based PrEP). PrEP use usually mirrored sexual behaviour, nearly all participants experienced a change in sexual behaviour, and felt it unnecessary to continue PrEP use when experiencing little or no sexual contact. Participants experienced reduced access to clinics and appointments during the pandemic, and advice on changing to event-based PrEP was varied with many participants needing more support. Loneliness was experienced by some resulting in varied response to lockdown rules, especially in the latter lockdowns.

Consequences

Implications: PrEP services in Wales have undergone major changes since the COVID-19 pandemic. This study provides patient perspectives on the challenges of reduced PrEP access during COVID. It offers insights into broader support needs around PrEP use when an individual’s circumstances change. Flexible models of PrEP provision, which can be adapted to the patient’s needs, will be essential as PrEP delivery extends into community settings such as GP clinics or community pharmacies.

Submitted by:

Zahraa Khammas

Funding acknowledgement:

This research is a secondary analysis of data from two previous studies which were funded by 1) Health and Care Research Wales for a post-doctoral fellowship, and 2) the KESS (Knowledge, Economy and Skills Scholarship) PhD scheme.