Maintaining access to HIV PrEP in a pandemic: PrEP-user and healthcare professional perspectives on a telephone-based PrEP service

Background: To maintain access to PrEP during the COVID-19 pandemic our PrEP service (1000 PrEP-users) shifted to a largely telephone-based model (tele-PrEP). A service evaluation of this tele-PrEP service was conducted to explore the views and experiences of PrEP-users and sexual health care professionals (HCPs) to understand the benefits and drawbacks to inform future service delivery. Method: Parallel web-based anonymous surveys of PrEP-users and HCPs were developed using validated questions wherever possible. The PrEP-user survey was offered to those who had a tele-PrEP appointment between 13.11.2020-17.12.2020 and consented to participation. All HCPs conducting tele-PrEP appointments were invited to participate. Basic demographic data was captured. Data were analysed in Excel using descriptive statistics. Free text responses were thematically categorised using the Framework for a Systems Approach to Healthcare Delivery. Results: Sixty-two PrEP-users and 8 HCPs completed the surveys (response rate 55% and 89% respectively). Demographic characteristics of PrEP-user respondents were broadly representative of our whole PrEP-cohort. Most PrEP-user respondents booked their tele-PrEP appointment using the online booking tool (54/62) and for follow up appointments (52/62). The service was rated “excellent” or “good” by 61/62 PrEP-users, and 59/62 would recommend it to friends. Of the 62 respondents, 49 would like to continue with tele-PrEP in the future and 10/62 would prefer face-to- face appointments. PrEP-users identified convenience as a key benefit along with access to PrEP with reduced potential for COVID-19 exposure. Drawbacks were largely technological, including poor connection or issues with online booking. All HCPs felt that tele-PrEP allowed them to assess patients safely and confidently. Seven of eight HCPs felt well supported to undertake tele-PrEP appointments. One HCP expressed a preference for face-to- face appointments. HCPs also rated its convenience highly and felt it enabled better use of limited face-to- face clinic capacity. However, HCPs thought that tele-PrEP might create barriers for vulnerable patients, particularly those with low digital, health and/ or English-language literacy. Conclusion: Tele-PrEP is feasible and highly acceptable. While most respondents rated the service highly, others identified a need or preference for face-to- face appointments. Therefore, our service will continue tele-PrEP whilst ensuring availability of face-to- face care for those who require or request it.