Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

O'Byrne, Patrick; Vandyk, Amanda; Orser, Lauren; Haines, Marlene

OBJECTIVE: To report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service. DESIGN: This was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ(2) testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained. SETTING: This study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada. PARTICIPANTS: Of all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN). PRIMARY AND SECONDARY OUTCOME MEASURES: Uptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN. FINDINGS: 69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period. CONCLUSIONS: Nurse-led PrEP is an appropriate strategy for PrEP delivery.