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. 2018 Jul 3;18(1):513.
doi: 10.1186/s12913-018-3324-2.

Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol

Malika Sharma  1   2   3 , Allison Chris  4 , Arlene Chan  5 , David C Knox  2 , James Wilton  6 , Owen McEwen  7 , Sharmistha Mishra  1   2   8   9   10 , Daniel Grace  11 , Tim Rogers  12 , Ahmed M Bayoumi  2   8   9   13 , John Maxwell  14 , Rita Shahin  4 , Isaac Bogoch  2   15 , Mark Gilbert  16 , Darrell H S Tan  17   18   19   20   21
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Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol

Malika Sharma et al. BMC Health Serv Res. .

Abstract

Background: Gay, bisexual and other men who have sex with men (gbMSM) in Canada continue to experience high rates of incident HIV. Pre-exposure prophylaxis (PrEP, the regular use of anti-HIV medication) reduces HIV acquisition and could reduce incidence. However, there are too few physicians with expertise in HIV care to meet the projected demand for PrEP. To meet demand and achieve greater public health impact, PrEP delivery could be 'decentralized' by incorporating it into front-line prevention services provided by family physicians (FPs) and sexual health clinic nurses.

Methods: This PrEP decentralization project will use two strategies. The first is an innovative knowledge dissemination approach called 'Patient-Initiated CME' (PICME), which aims to empower individuals to connect their family doctors with online, evidence-based, continuing medical education (CME) on PrEP. After learning about the project through community agencies or social/sexual networking applications, gbMSM interested in PrEP will use a uniquely coded card to access an online information module that includes coaching on how to discuss their HIV risk with their FP. They can provide their physician a link to the accredited CME module using the same card. The second strategy involves a pilot implementation program, in which gbMSM who do not have a FP may bring the card to designated sexual health clinics where trained nurses can deliver PrEP under a medical directive. These approaches will be evaluated through quantitative and qualitative methods, including: questionnaires administered to patients and physicians at baseline and at six months; focus groups with patients, FPs, and sexual health clinic staff; and review of sexual health clinic charts. The primary objective is to quantify the uptake of PrEP achieved using each decentralization strategy. Secondary objectives include a) characterizing barriers and facilitators to PrEP uptake for each strategy, b) assessing fidelity to core components of PrEP delivery within each strategy, c) measuring patient-reported outcomes including satisfaction with clinician-patient relationships, and d) conducting a preliminary costing analysis.

Discussion: This study will assess the feasibility of a novel strategy for disseminating knowledge about evidence-based clinical interventions, and inform future strategies for scale-up of an underutilized HIV prevention tool.

Keywords: HIV pre-exposure prophylaxis; HIV prevention; Implementation science; Knowledge translation; Medical education; Men who have sex with men; Task shifting.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was obtained from the St. Michael’s Hospital Research Ethics Board (REB # 16–348) and the Toronto Public Health Research Ethics Board (File #2016–16). Informed consent to participate is to be obtained from all participants.

Consent for publication

Not applicable.

Competing interests

Malika Sharma, Arlene Chan, Sharmistha Mishra, Mark Gilbert, Daniel Grace, Rita Shahin, Isaac Bogoch, Ahmed M. Bayoumi, Tim Rogers, John Maxwell, James Wilton, Owen McEwen and Allison Chris have no competing interests to declare.

Dr. David Knox has consulted for ViiV Health Sciences and received honoraria from Merck and Gilead Sciences.

Dr. Tan reports grants from Canadian Institutes of Health Research & Ontario HIV Treatment Network, during the conduct of the study; grants from Gilead, grants from ViiV Healthcare, and participation in clinical trials sponsored by GSK, outside the submitted work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Project Overview
Fig. 2
Fig. 2
Dissemination & Implementation Framework (adapted from [48])
See this image and copyright information in PMC

References

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