- A digital pathway for PrEP has been developed in Brighton and Hove to allow people to manage their PrEP digitally, reducing the number of appointments they need to attend
- A community clinic has also been set up and has had great success in engaging seldom-seen groups
- These place-based innovations mean despite significant demand for PrEP there is no waiting list for PrEP in the city.
Brighton and Hove received funding from the European Union’s Horizon 2020 programme to co-design and evaluate a digital pathway for people living with stable HIV – and in the last few years this app has been used as the basis for the co-creation of an equivalent digital service for PrEP.
The app, PrEP EmERGE, was launched in Brighton and Hove in April 2021 and supports a digital pathway for PrEP – meaning that once users have started on PrEP, they can visit the clinic in-person less frequently.
‘Convenient and time-saving’
Between the in-person visits, the users manage their PrEP via the app and are sent STI and HIV sampling kits through the post with results received via the app. The app has reminders about taking medication and users can order more if their supplies are low via a messaging function. It has proved popular. More than a quarter of the 2,200 PrEP-users in Brighton and Hove are now enrolled on the digital service.
Sexual Health Consultant Dr Jenny Whetham “A digital pathway is more convenient for many PrEP users and helps the service to manage capacity. PrEP EmERGE frees up an estimated 1,000 clinic appointments a year for us currently, meaning that we are able to see new PrEP starters, those who are symptomatic or need more time, and of course other sexual health and contraception service users.
“When the digital service is offered, most people are very keen to use it. We do a lot in our lives digitally so it is great to be able to offer people a convenient person-centred way to manage their PrEP. In our HIV service nearly half of patients are using our digital pathways and I would imagine in time we will get to something like that ratio.”
The technology is licensed to a not-for-profit company which was set up as part of the funding agreement with the EU. And it is through that that the digital service can be offered to other areas – with several already in talks about using it.
Setting up a community clinic
Alongside the app, a community clinic has also been established in partnership between the sexual health service, which is provided by University Hospitals Sussex NHS Foundation Trust (UHS), and the Terrence Higgins Trust (THT), which runs Brighton and Hove HIV prevention and promotion services.
The clinic has been running for nearly two years and now operates twice a week – on Monday and Thursday afternoons – at THT’s main offices in Brighton city centre to complement the work being done at the service’s main two NHS clinics.
Brighton THT manager Marc Tweed: said: “We know that gay, bisexual and men who have sex with men have much greater awareness of PrEP and are more willing to come forward for it. So the idea for the clinic was to develop something that would be more appealing to other groups, such as sex workers, migrants, the black and the trans and non-binary communities and women.
“It has a very different feel from an NHS clinic. It is a community space in a discreet part of the city centre. When people walk in there is not a waiting room. They are greeted by our staff and assessed before seeing the nurse for PrEP. That is important – some people simply will not go to a traditional NHS setting.”
But it is not just about the prescription – the service provides holistic care with staff discussing things such as risk reduction and wider sexual health care.
To raise awareness about the clinic, THT has run social media campaigns alongside promoting it during its outreach work although word-of-mouth has also played a role, said Mr Tweed. It has worked – over the past 12 months more than 100 people have started using PrEP via the community clinic.
Lead Sexual Health Nurse Kim Fortescue-Talwar said: “People like the service and that means we have been able to reach a very different group than our traditional NHS clinics do. Once people have started on PrEP we then find they are often happy to go to one of the our core clinics for the routine monitoring and follow up, but there is always the option of coming here if they prefer.”
Now the community clinic is well established, Brighton and Hove is exploring other options, including setting up pop-up clinics at venues used by the drug and alcohol service, refugees and sex workers.
And, as has been the case throughout, co-design with community and clinicians will be key to this work – supported by close working between partners from THT, University of Brighton and UHS.
Council Public Health Programme Manager Stephen Nicholson said: “There is a lot more we can do, but I am delighted with what has been achieved so far. It means we are increasing the number of people using PrEP across a wide range of groups and we are doing this without having a waiting list, which is quite unusual for PrEP and is something we are very proud of.”