Authors
S. Penon (1), L. Cosmaro (1), F. Falzetta (1), M. Oldrini (1), D. Savarino (1), A.R. Raccagni (2), C. Candela (2), S. Nozza (2),(3)
Affiliation
(1) Fondazione LILA Milano ETS, Milan, Italy, (2) Vita-Salute San Raffaele University, Milan, Italy, (3) Infectious Diseases Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
ABSTRACT
Background: PrEP effectiveness in preventing HIV infections calls for the expansion of dedicated services. In Italy access to PrEP is still insufficient, especially in the South and places far from infectious disease clinics and checkpoints. A team of community health workers (CHWs) and infectious disease specialists was constituted to offer online PrEP services (TelePrEP). When the pilot program started in Feb 2023, PrEP was not yet reimbursable and access to dedicated sites was delayed by long waiting times. Main objectives were to allow access to PrEP for those unable to access existing services, minimize use of informal PrEP by promoting safe uptake and adherence through adequate follow-ups and verify the actual feasibility of such approach.
Methods: TelePrEP offers access to an online service managed by CHWs and infectious disease doctors. File exchange (test and PrEP prescriptions, test results) and consultations are carried out by means of an ePlatform, so that clients can be effectively monitored for psychological and medical aspects. A dedicated database allows for collection of clients’ demographic and behavioral data, for M&E of TelePrEP activities and reminders for follow-up visits. Interested people residing near existing PrEP programs are referred to such services to benefit of drug refundability.
Results: In the 1st 13 months of activity (Feb’23-Feb’24), 200 people contacted TelePrEP for initial information; 108 were enrolled: 107 cis men and 1 cis woman. Data on age, education, professional condition, region of residency, sexual orientation, risk factors, reasons for accessing PrEP and contacting TelePrEP are detailed in Figures 1-9, respectively. Fifty-nine people were referred to existing PrEP services close to their residence that they had not heard about; 33 people after the 1st consultation decided not to proceed.
Thirty-five clients already attended follow-up visits (foreseen after 3, 6, 9 months); no one decided to quit PrEP. Overall, 66% of clients firstly opted for on-demand PrEP and 34% for daily PrEP; 9% referred to have switched from one to the other mostly due to specific occasions (vacation, Pride events…). Some transient side effects (nausea, chills, gastrointestinal problems) were reported in 34.8% cases. Concomitant use of chemsex, either “rarely” or “sometimes”, occurred in 8.6%, similarly to what reported during 1st consultations (8.3%). Condom use decreased if compared to what initially referred (Figure 10). Number of partners was reported as increased by 42.8% of clients, while it remained stable for the others (57.2%). No HIV infections occurred; 3 cases of gonorrhea and 1 of acute HCV infection were identified.
Conclusions: TelePrEP has proven to be an essential service due to persisting barriers in accessing PrEP services, even after drug refundability was approved; the program will continue at least till end 2024. Management of remote follow-up data is complex; improvements are being introduced to optimize it.
Allegati:
Lavoro presentato in occasione di ICAR 2024 - Italian Conference on AIDS and Antiviral Research
