Enhancing access to HIV pre-exposure prophylaxis (PrEP) through a community-based project in New Zealand

INTRODUCTION: New Zealand has maintained a low HIV prevalence through comprehensive screening, treatment, and prevention programmes. However, challenges remain with access to pre-exposure prophylaxis (PrEP) for at-risk populations, particularly men who have sex with men (MSM). AIM: This study aimed to evaluate the implementation and outcomes of a community-based project that expanded PrEP access via a Standing Order authorising peer HIV testers and pharmacists to initiate short-term PrEP prior to general practitioner follow-up. METHODS: Conducted between May 2020 and July 2021, the project involved collaboration between a community-based HIV support organisation, a general medical practice, and a community pharmacy in Auckland. Participants received an initial 10-day PrEP supply following a negative HIV rapid test and screening for contraindications, with follow-up laboratory testing and prescriptions managed by the practitioner and pharmacist team. RESULTS: Thirty-six clients enrolled (aged 22-60 years). Most identified as European (n = 16), Asian (n = 10), or Māori (n = 8). No participants seroconverted to HIV during the study. Six sexually transmitted infections were diagnosed and treated. A degree of hepatocellular damage was reported in one participant, and mild but transient liver enzyme elevation occurred in a further five participants. No renal toxicity was recorded. The mean duration of PrEP use was approximately 12 months. DISCUSSION: This project demonstrated that community-initiated PrEP under a Standing Order can be a safe, acceptable, and effective method for expanding HIV prevention services amongst MSM. This model supports future policy directions to broaden PrEP access through trained pharmacists and community channels.