Changing the model of HIV PrEP delivery – nurse-led telehealth in a metropolitan sexual health service: a retrospective analysis

Background Innovative models in HIV pre-exposure prophylaxis (PrEP) delivery are required to reduce the burden on clinical services and provide convenience and access for clients. A nurse-led telehealth PrEP clinic ('TelePrEP') with free multi-modal testing pathway has been developed at Sydney Sexual Health Centre (SSHC). Methods Using a multi-model testing pathway, we reviewed retrospective electronic medical record of TelePrEP consultations at SSHC. Primary outcomes were demographic and behavioural characteristics, rates of attendance of TelePrEP appointments and follow-up screening, and rates of PrEP initiation, re-initiation and continuation. Secondary outcomes were length of time from screening to TelePrEP appointment, duration of TelePrEP appointments, adherence to guideline-indicated laboratory testing, and rates of HIV/STI identified through screening. We compared outcomes between the three screening pathways and by Medicare status. Results A total of 472 clients were reviewed. Majority were cis -gender male (99%), non-Medicare (77%), and overseas-born (86%). There was no significant difference in attendance rates between the three screening pathways. The majority of appointments referred through MyCheck (82%) resulted in PrEP continuation; 36% attended follow-up screening, with the highest rates of follow-up referred through a[TEST] (44%), and lowest through Xpress (22%). More non-Medicare clients (38%) attended follow-up screening than Medicare clients (27%). Adherence to national guidelines for testing was high, and screening identified two new HIV diagnoses. Conclusion Nurse-led TelePrEP model is feasible in overcoming issues of accessibility for key population groups including overseas-born MSM. We achieved high overall attendance rates, high adherence to guideline-indicated laboratory monitoring, and rapid linkage to treatment for clients with HIV identified on screening.