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Decentralizing PrEP delivery: implementation and dissemination strategies to increase PrEP uptake among MSM in Toronto, Canada

Citation

Charest, Maxime; Tan, Darrell H. S. (2021), Decentralizing PrEP delivery: implementation and dissemination strategies to increase PrEP uptake among MSM in Toronto, Canada, Dryad, Dataset, https://doi.org/10.5061/dryad.tx95x69x5

Abstract

Pre-exposure prophylaxis (PrEP) is traditionally prescribed by HIV specialist physicians. Given finite specialist resources, there is a need to scale up PrEP delivery by decentralizing services via other healthcare professionals. We aimed to assess the feasibility of delivering PrEP to men who have sex with men (MSM) through primary care physicians and sexual health clinic nurses. We piloted a multi-component, implementation and dissemination research program to increase provision of PrEP through primary care physicians and sexual health clinic nurses in Toronto, Canada. Community-based organizations (CBOs) provided prospective participants with information cards that contained links to an online module on engaging providers in a conversation about PrEP. In our patient-initiated continuing medical education (PICME) strategy, participants saw their family doctors and gave them the card, which also contained a link to a Continuing Medical Education module. In the nurse-led strategy, participants visited one of two participating clinics to obtain PrEP. We administered an optional online questionnaire to patients and providers at baseline and six months. CBOs distributed 3043 cards. At least 339 men accessed the online module and 196 completed baseline questionnaires. Most (55%) intended to visit nurses while 21% intended to consult their physicians. Among 45 men completing follow-up questionnaires at 6 months, 31% reported bringing cards to their physicians and obtaining PrEP through them; sexual health clinics delivered PrEP to 244 patients. Participants who went through the PICME approach reported no changes in relationships with their providers. Nurses showed fidelity to PrEP prescribing guidelines. Nurse-led PrEP and patient-initiated continuing medical education (PICME) for primary care physicians are feasible strategies to increase PrEP uptake. Nurse-led PrEP delivery was preferred by most patients.

Methods

The methods for data collection can be found in the following articles: Sharma M, Chris A, Chan A, et al. Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol. BMC Health Serv Res;18:513. doi:10.1186/s12913-018-3324-2; Charest M, Sharma M, Chris A, et al. Decentralizing PrEP delivery: Implementation and dissemination strategies to increase PrEP uptake in Toronto, Canada. PLOS ONE; in press. 

Data were collected via an online survey platform. Participants who did not consent to the study or did not complete the questionnaire were removed from the dataset. Missing data were left as is and assigned a value of -99, which was an impossible value in our dataset. Participants' answers were initially textual (e.g., very satisfied) and were assigned numeric values which are described in the ReadMe file. 

Funding

CIHR, Award: HIM 145368

Canadian HIV Trials Network, Canadian Institutes of Health Research, Award: CTN 303

Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Award: 16-004

CIHR, Award: HIM 145368