How to increase HIV testing and facilitate access to PrEP in General Practice? Designing an intervention using the person-based approach

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

1C.2

Presenter:

Anne Scott

Co-authors:

Jo Burgin, Joanna Copping, Hannah Family, Lindsey Harryman, Jeremy Horwood, Jo Kesten, Ann Sullivan, Sarah Denford

Author institutions:

University of Bristol, NIHR Applied Research Collaboration (ARC) West, Bristol City Council (Communities and Public Health), NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Unity Sexual Health, Bristol, Chelsea and Westminster Hospital NHS Foundation Trust

Problem

Increased testing for HIV and access to PrEP (drugs taken by HIV negative people before and after sex that reduce the risk of HIV transmission) is crucial for early diagnosis, treatment, and prevention of transmission. People living with HIV who are diagnosed early and are on effective treatment cannot transmit HIV sexually and can expect a similar lifespan to that of the general population. However, late diagnosis rates remain high, leading to poorer outcomes for patients, increased transmission risks and higher treatment costs. General Practice (GP) could play a key role in maximising testing opportunities and raising PrEP awareness. This study aimed to develop an intervention prototype designed to increase HIV testing and facilitate access to PrEP within GP.

Approach

In accordance with the person-based approach, we conducted scoping reviews and consulted experts to understand the barriers and facilitators to HIV testing and access to PrEP in GP . Subsequently, semi-structured interviews with healthcare practitioners (HCPs) and stakeholders were conducted to comprehend the challenges and identify potential solutions. The intervention design process followed an iterative approach, documenting the results of reviews, expert consensus, and qualitative data in a planning table. Focus groups were held with HCPs and the public to develop the intervention, designed to address barriers and support facilitators. Then, the proposed content was mapped to elements in a behaviour change model. Purposeful sampling was used to select general practices with a range of locations, HIV prevalence and testing rates, and public participants with a diversity of age, ethnicity, and gender.

Findings

The main barriers identified through the scoping review and the interviews included lack of knowledge and awareness of HIV and PrEP, stretched HCP resources with little time to discuss and carry out tests and a lack of systematic ways to identify who to test. HCPs and stakeholders proposed strategies for increased testing. HCPs were keen to receive HIV/PrEP training and suggested ways that this could be delivered. HCPs wanted simpler ways to provide a test, to normalise the testing process, and to reduce HIV stigma. Based on these insights, three key components of the prototype intervention were developed. First, the provision of HCP education and training to raise awareness of HIV testing and PrEP. Second, a simplified and streamlined approach to testing by adopting an opt-out approach integrated into routine healthcare. Third, a systematic way to identify who to test by embedding a clinical decision support application within the electronic health record.

Consequences

Utilising a theory, evidence and person-based approach enabled the development of a new multicomponent intervention focused on increased testing and access to PrEP within GP. Testing the effectiveness of the intervention will be a key next step in the goal to improve health outcomes in HIV.

Submitted by:

Anne Scott

Funding acknowledgement:

NIHR School for Primary Care Research, NIHR Applied Research Collaboration (ARC) West