P238 Right test, right time: ensuring timely renal function monitoring in clients taking PrEP

Golden, J.; Harryman, L.

BackgroundClients receiving PrEP (HIV Pre-Exposure Prophylaxis) require renal function (estimated Glomerular Filtration Rate (eGFR)) monitoring as detailed in BASHH/BHIVA guidelines. Annual monitoring is required for individuals < 40 with normal baseline eGFR and no risk factors for kidney disease. Our busy urban sexual health clinic lacked a structured system for eGFR monitoring, with concern clients were being tested unnecessarily or not at all.MethodA retrospective review was conducted of all clients under 40 years who received PrEP between June and November 2020. eGFR results and additional tests performed without clinical justification were extracted from records in the year preceding the issue of each PrEP prescription. The number of unnecessary repeat eGFRs within 12 months was recorded.Results199 clients were identified of whom 186 (93.5%) had eGFR checked in the year prior to issuing PrEP. 13 clients (6.5%) therefore had inadequate eGFR monitoring whilst continuing to take PrEP.Of those tested, 55 (29.6%) had eGFR re-checked within a year without clinical justification with a total of 69 unnecessary tests performed. This equates to £345 expenditure on tests, six hours of clinical time administering results and over-investigation of clients with minor fluctuations in eGFR.We implemented a new pathway for eGFR testing, including a visible alert on each client’s record allowing clinical staff to immediately see when the eGFR was last checked, and when the next is due.ConclusionThis study identified both under- and over-testing of eGFR for clients taking PrEP. Whilst it is vital that eGFR testing is not missed, over-testing wastes clinical and financial resources which are at a premium in an era of budgetary constraints and reduced appointment availability due to COVID-19. As the number of clients taking PrEP increases, it is important for all services to ensure robust and efficient methods of eGFR monitoring.