Photo Credit: Prathan Chorruangsak
An end-to-end digital PrEP pathway appeared to improve accessibility, inclusivity, and service satisfaction among LGBTQ+ patients, according to recent findings.
A digital pre-exposure prophylaxis (PrEP) pathway appeared to improve accessibility, inclusivity, and service satisfaction among patients using PrEP to protect against HIV, according to findings published in the International Journal of STD & AIDS.
The researchers from the United Kingdom noted that, like issues seen in the US, the MPox outbreak and other demands on the healthcare system impacted access to PrEP for certain patients. Still, the UK has set an official goal of reducing new HIV infections to zero by 2030. Ending the HIV Epidemic in the US has established similar goals, with aims to reduce new HIV infections in the country by 75% by 2025 and by 90% by 2030.
“To our knowledge, this is the first service evaluation that provides early evidence from both an operational and user-feedback perspective to support an end-to-end digital PrEP service … for LGBTQ+ populations,” Christopher El Badaoui, BBA, and colleagues wrote. “The pilot looked to address some previously cited concerns regarding digital PrEP.”
One such concern is the availability of suitable screening for all users before receiving a PrEP prescription, according to Badaoui and colleagues.
Study Parameters
The researchers performed a cross-sectional retrospective study of the LVNDR Health digital PrEP pathway, a mobile application connecting PrEP users with clinicians for online prescriptions and appointments, from December 2022 to April 2023. LVNDR is a digital clinic for LGBTQ+ patients developed with input from national health agencies, researchers, and more than 800 members of the LGBTQ+ community. The LVNDR pilot app was available to patients as an Apple or Android mobile download. Patients received a link to download the app, provided personal and clinical details, and completed remote blood and urine testing before initiating PrEP.
El Badaoui and colleagues evaluated operational data, such as appointment attendance, from the clinician dashboard, and sought user feedback. A total of 90 participants completed a questionnaire specifically designed for the study, representing slightly more than 10% of the clinic’s monthly 180-patient load over 4 months.
Participants were mostly cisgender men (80.5%). Other groups included cisgender women (2.7%), transgender men (5.3%), transgender women (2.7%), nonbinary people (7.1%), and gender-fluid people (1.8%). Patients described their sexual orientation as gay (69%), bisexual (14.2%), queer (11.5%), pansexual (3.5%), demisexual (0.8%), or asexual (0.8%).
Most participants were White (70.7%), and most of the study population was either currently taking PrEP (52.2%) or had previously used the treatment (24.8%).
Uptake & Satisfaction of PrEP in a Digital Setting
After the initial testing and screening process, users booked 97 appointments during the pilot period. In 90 of these appointments (92.8%), app users attended their appointments.
It took participants an average of 2.7 weeks to complete the pathway from end to end, El Badaoui and colleagues reported. Appointments lasted an average of 24 minutes (range, 11-57), and nearly all users (94%) received their PrEP medication within 48 hours of the appointment. For those whose prescriptions took longer than 48 hours, the delays were explained by issues with delivery, such as lost packages or a change of address. However, follow-up deliveries ensured that every participant in the study received their prophylaxis prescriptions, according to the researchers.
The response rate to follow-up feedback surveys was 71.0%. After the researchers excluded 10 patients who had no prior experience with PrEP, 54 participants rated the LVNDR pilot program more favorably than their previous method of obtaining PrEP.
“An end-to-end digital PrEP service may offer a suitable adjunct pathway to improve PrEP access and uptake among LGBTQ+ and other populations at risk for HIV transmission,” Wells and colleagues concluded in their article. “Further work is required to determine feasibility at scale, needs of digitally excluded populations, and the potential health-economic impact for NHS organizations providing PrEP services.”
