Simplifying PrEP: Is monitoring needed?

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SY27

Symposium

Track C - Epidemiology and prevention science

CME accredited

Room 14b/Channel 3

25 July 15:00 - 16:00

MODERATOR

Sheena McCormack
MRC Clinical Trials Unit at UCL, United Kingdom

Current TDF-based PrEP programmes generally require regular monitoring for renal and bone health, with regular HIV and STI testing. This introduces complexity into the set-up and implementation of national PrEP programmes and, in some settings, has limited the number of people who are able to access PrEP. PrEP based on other drugs (such as LA CAB) may reduce the need for some aspects of this monitoring, but STI/HIV testing requirements are likely to remain. Following the COVID-19 pandemic, the population is more used to self-testing, and new technologies have opened opportunities for new approaches to self-care. This could pave the way for people receiving PrEP to take responsibility for their own monitoring and/or testing, reducing the impact on PrEP delivery systems. It remains unclear, however, whether this would be feasible or acceptable to those receiving PrEP and whether it could increase rather than decrease inequalities.

Presentations
Rapporteur Summary

15:00 2 min	Introduction Sheena McCormack MRC Clinical Trials Unit at UCL, United Kingdom

15:02 10 min	Why does PrEP have to be so complicated? Sinead Delany-Moretlwe Wits RHI, South Africa

15:12 30 min	Panel discussion Nittaya Phanuphak Institute of HIV Research and Innovation, Thailand Will Nutland PrEPster, United Kingdom Junine Toy BC Centre for Excellence in HIV/AIDS, Canada Douglas Krakower Beth Israel Deaconess Medical Center, United States

15:42 18 min	Q&A and conclusion Sheena McCormack MRC Clinical Trials Unit at UCL, United Kingdom Sinead Delany-Moretlwe Wits RHI, South Africa Nittaya Phanuphak Institute of HIV Research and Innovation, Thailand Will Nutland PrEPster, United Kingdom Junine Toy BC Centre for Excellence in HIV/AIDS, Canada Douglas Krakower Beth Israel Deaconess Medical Center, United States

AUTHOR

Njambi Njuguna

SUMMARY

This session involved a panel discussion on simplifying PrEP delivery for scale-up. Currently, barriers to oral TDF-based PrEP access include testing for HIV and renal function, and STI screening. The discussion focused on whether decreased monitoring, in some cases through differentiated service delivery, could be safe, feasible and acceptable.

HIGHLIGHTS

Sinead Delany-Moretlwe (Wits RHI) described how community-based ART delivery models have provided valuable lessons for simplifying PrEP delivery through decreased contact with the health system. Nittaya Phanuphak (Institute of HIV Research and Innovation) described how lay providers delivered 80% of PrEP in Thailand with only 15 community sites, underscoring the importance of community models. Will Nutland (PrEPster) cautioned that we needed to make PrEP more accessible or risk a return to “PrEP in the wild”. The panel concurred that an HIV test was really the only prerequisite to initiating PrEP with most favouring an increased role for HIV self-testing (HIVST). Douglas Krakower (Beth Israel Deaconess Medical Center) emphasized that while an enhanced PrEP service package was desirable, less conservative approaches were needed to reach harder-to-reach populations. Junine Toy (BC Centre for Excellence in HIV/AIDS) highlighted that pharmacy-based care, whether over the counter or behind the counter, is a viable model to increase PrEP coverage especially when combined with HIVST. Overall, the panel concluded that person-centred care is critical as there are populations, like adolescents or other historically neglected groups, where regular contact with the healthcare system, and perhaps even more monitoring to build trust, may be important for PrEP persistence.

CRITICAL ASSESSMENT

Simplifying PrEP delivery is crucial for scaling up its use. Approaches must be person-centred, engage community actors, and adapt to users’ needs. We need to build structures to adopt technologies that take PrEP further into self-care. As Sinead Delany-Moretlwe said, we must “take the ones who can manage their health out of the health system to make room for those who need it”. Differentiated service delivery for PrEP offers a platform to do this, improving efficiency without compromising quality. Panellists agreed that we should not let “the perfect be the enemy of the good”.