After 8 years of lobbying and campaigning by HIV activist and advocacy organisations, PrEP became available in England in 2020. PrEP, or Pre-exposure Prophylaxis, is a medicine for people at risk of acquiring HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV. The challenge now is to make PrEP as accessible as possible to everyone who needs it.
Building on research and innovation originating from the Horizon 2020 funded EmERGE project, the Centre for Digital Media Cultures Research at the University of Brighton has been working with people who use PrEP and a multi-partner group including University Hospitals Sussex NHS Trust’s Lawson Unit and the Terrence Higgins Trust. Their work has led to the co-design, development and implementation of an app and clinic-based review system to support people to use PrEP through UK sexual health services. The original idea and co-design process was initiated in September 2019 by the European Aids Treatment Group and the Terrence Higgins Trust. The app went live in clinic in April 2021 and is currently available for eligible patients to use in alongside their normal face-to-face care.
The PrEP App – for patients
The app makes PrEP medication easy to access and straightforward to use. It also makes regular testing more accessible. Instead of attending 3-monthly tests at a sexual health clinic, app users have the option to receive home self-testing kits, reducing the number of times that people need to attend clinic. Having used the kit, they receive their results via the app if their test is clear. If the test isn’t clear, the user will be telephoned by the clinic to talk through the results and discuss next steps for healthcare. The app supports users to stay on top of their sexual health testing history, appointments and results. It provides easy access to advice and support, explaining what test results mean and providing FAQs and contact information for local services.
The PrEP App and clinic-based system for medical review – for clinicians
Use of the app is supported by a clinic-based system for medical review which ensures every PrEP user who attends clinic has their test results and medication carefully considered by a doctor. During the Covid pandemic, this enhanced potential for ‘care at a distance’ proved vital. Knowing people have received their test results securely as part of a ‘digital care pathway’ ensures care quality and standards, and under normal circumstances, enables clinics to manage the increased footfall that a greater uptake of PrEP brings. The pathway is implemented through a supportive co-design process that enables clinics to look systematically at how they manage capacity across their processes from both a service user and clinical point of view. In addition, because the pathway links community and clinic, more opportunities for increased access, support and coordinated campaigning are created.
The PrEP App – for community partners
Introducing the app to a local area brings clinic and community providers closer together. Advice and local support information held in the app is created collaboratively. This has the advantage of ensuring it meets the needs of people who are under-served by mainstream services and creates shared opportunities for promoting sexual health awareness and inclusivity. Integrating community-based testing and advice means ‘every open door’ to PrEP awareness is signposted and allows a local network of support to form around app use. Working with community also ensures policy and service innovation retain a focus on those who prefer a non-digital approach to care, or are digitally excluded.
The PrEP app supports users to stay healthy by connecting them to the information and advice they need. Access to accurate, reliable, up-to-date medical data is placed ‘in their hands’ creating additional opportunities to stay connected to services and support. A place-based, clinic-community approach ensures that sexual healthcare associated with PrEP use is inclusive and accessible. Dr Darking says, ‘Having fought so hard for access to PrEP, it is only right that we work collaboratively and innovatively to ensure awareness and access to care’.
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