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

Abstract

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 χ² 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.

Keywords: HIV & AIDS; public health; sexual medicine.

Figure 1

(A) PrEP-RN initiation and retention numbers. (B) f/u, follow-up; PrEP-RN initiation and retention rates. PrEP-RN, pre-exposure prophylaxis-registered nurse.