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  • Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study

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Health services research
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Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study
  1. Ceilidh Grimshaw1,2,
  2. Claudia S Estcourt3,
  3. Rak Nandwani2,
  4. Alan Yeung3,4,
  5. David Henderson4,
  6. John Michael Saunders5,6
  1. 1 Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2 Brownlee Centre for Infectious and Communicable Diseases, NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
  4. 4 Blood borne viruses and sexually transmitted infections section, Public Health Scotland, Glasgow, UK
  5. 5 HIV & STI Department, Public Health England, London, UK
  6. 6 Research Department of Infection and Population Health, University College London, London, UK
  1. Correspondence to Dr Ceilidh Grimshaw, Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow G379B, UK; ceilidh.grimshaw{at}ggc.scot.nhs.uk

Abstract

Objectives To review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies.

Methods We extracted data from national HIV databases (July 2015–June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of ‘potentially preventable’ infections with the sexual health clinic–based PrEP delivery model used.

Results Those diagnosed with HIV before PrEP implementation were more likely to be male (342/418, 81.8% vs 142/197, 72.1%, p=0.005), be white indigenous (327/418, 78.2% vs 126/197, 64.0%, p<0.001), report transmission route as sex between men (219/418, 52.4% vs 81/197, 41.1%, p=0.014), and have acquired HIV in the country of the programme (302/418, 72.2% vs 114/197, 57.9% p<0.001) and less likely to report transmission through heterosexual sex (114/418, 27.3% vs 77/197, 39.1%, p=0.002) than after implementation.

Pre-implementation, 8.6% (36/418) diagnoses were ‘potentially preventable’ with the PrEP model used. Post-implementation, this was 6.6% (13/197), but higher among those with recently acquired HIV (49/170, 28.8%). Overall, individuals with ‘potentially preventable’ infections were more likely to be male (49/49, 100% vs 435/566, 76.9%, p<0.001), aged <40 years (37/49, 75.5% vs 307/566, 54.2%, p=0.004), report transmission route as sex between men (49/49, 100% vs 251/566, 44.3%, p<0.001), have previously received post-exposure prophylaxis (12/49, 24.5% vs 7/566, 1.2%, p<0.001) and less likely to be black African (0/49, 0% vs 67/566, 11.8%, p=0.010) than those not meeting this definition.

Conclusions The sexual health clinic–based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present.

  • PrEP
  • HIV pre-exposure prophylaxis
  • HIV
  • service delivery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/sextrans-2020-054732

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    Footnotes

    • Handling editor Jane S Hocking

    • Twitter @kleegrim, @drrakn, @saunders_j

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors All authors have reviewed and approved the final manuscript which is being submitted. CG: study protocol and design, data collection, data analysis, discussion, preparation of manuscript, manuscript revision, responsible for overall content. CSE: study protocol and design, data analysis, discussion, preparation of manuscript, manuscript revision. RN: study protocol and design, data analysis, discussion, preparation of manuscript, manuscript revision. AY: study protocol and design, data analysis, preparation of manuscript. DH: study protocol and design, data collection, review of manuscript. JMS: study protocol and design, data analysis, discussion, preparation of manuscript.

    • 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.