Implementing a Nurse-led HIV Pre-exposure Prophylaxis Service (PrEP-RN) in a Public Health Unit STI Clinic: A Public Health Reform Analysis

Abstract

HIV pre-exposure prophylaxis (PrEP) is an efficacious pharmacologic HIV prevention strategy aimed at persons who are high-risk for HIV infection. Historically, PrEP uptake has been limited by systems-level barriers relating to the high cost of medications and few prescriber access points. In Ottawa, a team of researchers and clinicians sought to increase PrEP access to priority groups by implementing a fully nurse-led PrEP service, known as PrEP-RN, as part of the public health unit s sexual health clinic. This program was the first of its kind in Canada and required consideration from multiple stakeholders within the public health unit, and the Ottawa community. Patients at highest risk for HIV acquisition were offered a referral to PrEP-RN through a provider-driven, active-offer process by public health nurses, and medication coverage was provided to uninsured patients to ensure equal access to PrEP services. Preliminary results showed a 40% uptake of PrEP referrals among high-risk patients, demonstrating that this reform has been effective at reaching some priority groups; however, many persons continue to decline PrEP due to individual perceptions of risk (i.e., feeling they do not need this HIV prevention intervention). \n\xa0La prophylaxie pre-exposition au VIH (PrEP) est une strategie pharmacologique efficace de prevention du VIH destinee aux personnes a haut risque d infection par le VIH. Historiquement, l adoption de la PrEP a ete limitee par des obstacles au niveau des systemes lies au cout eleve des medicaments et par le nombre reduit de points d acces pour les prescripteurs. A Ottawa, une equipe de chercheurs et de cliniciens a cherche a ameliorer l acces de la PrEP aux groupes prioritaires en mettant en place un service de PrEP dirige par une infirmiere, appele PrEP-RN, dans le cadre de la clinique de sante sexuelle du bureau de sante publique. Ce programme etait le premier du genre au Canada et a necessite l attention de nombreux intervenants au sein du bureau de sante publique et de la communaute d Ottawa. Les infirmieres de la sante publique ont propose aux patientes presentant le risque le plus eleve de contracter le VIH d etre dirigees vers une RNP-RN dans le cadre d une offre active, et une couverture en medicaments a ete fournie aux patients non assures afin d assurer un acces egal aux services de PrEP. Les resultats preliminaires ont montre une acceptation de 40% des references a la PrEP chez les patients a haut risque, qui demontre que cette reforme a ete efficace a fournir des services a quelques groupes prioritaires, mais plusieurs personnes continuent de refuser la PrEP a cause de leur perception du risque (c’est-a-dire, ils pensent ne pas etre a risque pour le VIH).