Pre-exposure prophylaxis for HIV (PrEP) has been shown to reduce transmission of HIV in a number of trials; however, there is limited evidence regarding the optimal way to deliver PrEP through pre-existing UK services, particularly through fully integrated drop-in sexual health service models. PrEP in the form of Truvada was launched in Wales in July 2017. We set up a PrEP service to be delivered via our drop-in integrated sexual reproductive health service. In the first 5 months of PrEP service provision, we found unforeseen levels of comorbidity, polypharmacy and renal impairment in our cohort of PrEP patients. As a result, we have altered our service model and all patients are now followed up in booked appointment PrEP clinics run by members of the HIV team. Those patients with estimated glomerular filtration rate (eGFR) of 60–70 mL/min or with eGFR of 60–80 mL/min and with comorbidities impacting on renal function are monitored every 4–6 weeks initially, and PrEP has been incorporated into our pre-existing virtual HIV renal clinic for discussion with a renal physician. The PrEP team clinicians report that monitoring and managing the PrEP cohort is now easier in its appointment-only format, although some patients have reported that they would prefer a drop-in system.
- sexual health
- public health
- primary prevention
- pre-exposure prophylaxis
- integrated sexual reproductive health service
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Handling editor Sarah K Edwards
Contributors CK, ZC and ATJ sit on the HIV Expert Group and contributed to writing the Welsh Guidance listed for the roll-out of PrEP in Wales. CK set up the PrEP service in our department. CK, IP and HB see and manage the PrEP patients. CK collected the data and wrote the article, and all the authors read it and contributed to changes after the first draft. CK, ZC and ATJ wrote the revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement We are very happy to share any further information requested about the PrEP service.