The Scottish ePrEP Clinic

Why are we developing the ePrEP clinic?

HIV pre-exposure prophylaxis (also known as PrEP) is a game-changing addition to the HIV prevention toolkit. PrEP is a pill that people take to reduce their likelihood of getting HIV. PrEP has been available in Scotland from NHS sexual health clinics since 2017. Research led by GCU has shown how effective PrEP can be in reducing the number of people getting HIV.

In Scotland, if people want to get more PrEP, they have to go to a sexual health clinic every three months for a review appointment. These reviews are opportunities to test for HIV and sexually transmitted infections, which people on PrEP should do regularly. The reviews are also an opportunity to discuss continuing PrEP with a healthcare professional (a doctor or specialist nurse) and any issues they might be experiencing.

Because of all of the advances in HIV prevention, we could reach the point where people are not getting HIV anymore. If we want this to happen, we need to make sure that everyone who would benefit from PrEP can access it. While this is important and needed, it will increase demand for sexual health clinic appointments. Sexual health clinics are already finding it challenging to cope with demand, so we need to think of ways to support them and the people using them.

We are developing an online PrEP service, which we call ‘the ePrEP clinic’. The idea behind this is that some people who are already using PrEP do not need much input from a doctor or nurse because they are relatively healthy and take their PrEP when they should. If we were able to give these people the option of managing their PrEP at home, it would free up some space within the sexual health clinics, so we can get more people on PrEP.

What is the ePrEP clinic?

The ePrEP clinic is a different way of completing the three-monthly PrEP reviews and testing. Depending on the person, this means they might only have to go into the clinic once or twice a year instead of four. It will be voluntary and people can choose to stick with, or go back to, in-clinic care if they want. We have broken the ePrEP clinic down into three stages.

Stage 1: People collect their own samples to test for HIV and other sexually transmitted infections.

When it is time for a person’s PrEP review, the clinic will send them a text message letting them know with a link to order their self-sampling kit. When they have their kit, the person will do their own swabs and collect a urine sample. They will also collect a finger-prick blood sample. When they have collected these samples, they will put these in a package that came with the kit and post it back to the clinic or a laboratory for testing.

Stage 2: People fill in an online PrEP assessment questionnaire.

When the person returns the self-sampling kit, the clinic will send them a text message with a link to their online PrEP assessment questionnaire. The questionnaire includes similar questions that doctors and nurses ask during the PrEP reviews in clinic. People will be able to complete these on a smartphone, tablet, or computer.

Stage 3: Healthcare professional review and PrEP prescription.

A healthcare professional will review the HIV and sexually transmitted infection test results and the answers to the online PrEP assessment. The healthcare professional will phone the person if they need treatment or need to discuss anything that came up in the online PrEP assessment. If there were no issues, the healthcare professional will prescribe more PrEP. It is the person’s choice if the clinic posts their PrEP to them or if they collect it from a community pharmacy.

What have we done so far?

We have already done a lot of research on the ePrEP clinic:

• We did a survey of PrEP users asking if they were interested in using the ePrEP clinic. 76.8% said they were likely or very likely to use the ePrEP clinic if it was available to them.
• We developed the questions for the online PrEP assessment. We ran these by PrEP users to make sure they were clear and made sense.
• We talked to PrEP users and asked what they thought of the ePrEP clinic. They thought that the ePrEP clinic would be convenient, offer privacy, and would give people more control over their PrEP care. We also found ways we can support people to use the ePrEP clinic successfully.
• We talked to doctors and nurses and asked what they thought of the ePrEP clinic. They expected many of the people using their service would like the ePrEP clinic. They also talked about times when in-person/in-clinic care would be more appropriate for some users.

What is next?

The Scottish Government has funded us to continue our research and rollout the ePrEP clinic. Soon, we will begin to recruit participants for a study testing out the online PrEP assessment. At the same time, we will work with software developers to start to build the ePrEP clinic interface.