Nurse-Led Models of PrEP Delivery Integral to Facilitating Uptake

Nurses are in a unique position to facilitate uptake of pre-exposure prophylaxis (PrEP), but their ability to do so can depend on the facility in which they work.

In Australia, prior to April 2018, only HIV specialists were allowed to prescribe PrEP, and only HIV/sexual health specialist nurses working in specialist settings were able to aid in conducting PrEP assessments and assist with 3-month medication supply. That changed when the medication was added to the government-subsidized Pharmaceutical Benefits Scheme (PBS), allowing all physicians to prescribe it.

QPrEPd, a multi-site, open-label PrEP Demonstration Project launched in Queensland in 2016, evaluated the role of HIV/sexual health specialist nurses as they conducted PrEP assessments and 3-month medication supply after prescription by an HIV physician.

Because the study commenced before 2018, however, little is known about the role of nurses supporting PrEP-prescribing physicians in non-specialist settings.

In a late-breaking abstract presented at the Association of Nurses in AIDS Care Conference (ANAC 2019), investigators with the University of Queensland, Cairns Sexual Health Service, and Hinterland Hospital and Health Service assessed the feasibility and acceptability of PrEP provision through public sexual health services (PSHS) and specialist HIV General Physician practices (GPP).

The research team conducted a longitudinal mixed methods evaluation and relied on QPrEPd participants to explore the role of HIV/sexual health specialist nurses in PrEP provision in Australia and their perceptions of PrEP-provision in non-specialist settings.

The study integrated data from the QPrEPd implementation, including interviews with 33 QPrEPd participants and 51 PrEP providers (including 18 HIV/sexual health specialist nurses).

Six months post-study, investigators conducted follow-up interviews on transition to PBS with 13 participants, 10 HIV physicians, and 27 HIV/sexual health specialist nurses.

Nurses stationed in PSHS and specialist HIV GPP study sites were integral in facilitating rapid PrEP uptake among individuals at high risk of acquiring HIV in Queensland, investigators found, while nurse input was restricted in the physician-led model of PrEP provision in PBS.

“Participant reports of inadequate [sexually transmitted infection] testing, refusal to prescribe, discrimination, and stigmatization in generalist settings raised concerns of generalist nurses and physician preparedness to prescribe PrEP and provide comprehensive sexual health care and the roll-on associated risk of harm this may have among at-risk populations,” the authors reported.

This study emphasized the need for responsive models of nurse-led PrEP delivery, especially in regional areas where providers may have limited PrEP knowledge.

“Nursing involvement across a range of practice settings is essential to foster comprehensive HIV prevention pathways for priority populations,” investigators concluded. “Education of generalist nurses and physicians must incorporate clients’ broader sexual health, and HIV/STI testing needs in addition to addressing stigma and discrimination.”

The study, HIV Pre-exposure prophylaxis provision in Australia: Nurses are key to increasing access and uptake, was presented Friday, November 8, 2019, at the Association of Nurses in AIDS Care Conference (ANAC 2019) in Portland, Oregon.