Liverpool’s sexual health service provider Axess has improved access by setting up a PrEP Express service from its three sexual health clinics.
- Express PrEP service set up offering same-day quick appointments for non-complex cases
- Outreach team work with targeted groups including sex workers and Black African communities
- Push on getting more women using PrEP with women-only booking sessions to be offered from sexual health clinics.
A PrEP prescription normally requires people to have an appointment with a nurse or doctor, limiting the amount of appointments services can offer. But Liverpool’s sexual health service provider Axess has improved access by setting up a PrEP Express service from its three sexual health clinics.
The service allows people to access repeat PrEP prescriptions via a consultation with a non-registered health practitioner. Users can fill in an online questionnaire and even do their HIV testing in advance.
If there has been no changes and it is a straightforward repeat prescription they are invited to attend a consultation with a non-clinical sexual health practitioner to get their supply of PrEP.
A same-day service
Axess Clinical Director Dr Martyn Wood said: “Traditionally people would have to see a doctor or nurse, but by offering this service we are able to provide more appointments. People are in and out in 15 minutes and we can offer same-day appointments if people need them.
“The online assessment filters out the more complex cases that need to be seen by a nurse or doctor. That includes occasions where there has been a change in circumstances, perhaps the individual has started a new medication or something like that.”
Around 50 per cent of PrEP consultations are now with a non-registered practitioner after the first Express service was introduced two years ago.
Dr Wood said: “It has proved incredibly popular. In fact, one lesson for us was that you need to be prepared for the demand. When we first started the Express clinics we were a little overwhelmed.
“What we have also noticed is that way people use PrEP has evolved. When it started being prescribed we all envisaged people would be on it constantly. But instead we have found people come on and off it depending what is happening with their sex lives.
“People have periods where they are not sexually active or be with a partner where you know their HIV status. It means a three-month supply can last six months. Because of that people need clear advice on how to do that to ensure there is active PrEP in their body.”
This year should see a further development of the PrEP offer with the creation of a digital service, which will allow users to carry out the online assessment and self-test for HIV and then get their supply of treatment posted out to them. Again it will only be for the most straight-forward repeat prescriptions.
Widening access through targeted work
While demand has been high for PrEP, the majority of it has come from the gay, bisexual and men who have sex with men (GBMSM) community. To widen access Liverpool is now planning a promotional push to get more women to come forward.
Alongside the three dedicated sexual health clinics, there is a network of women’s health hubs where staff are routinely having conversations about PrEP with women who fall into at-risk groups.
“They are opportunistic conversations,” said Dr Wood. “We want to normalise PrEP to create a situation where women will naturally think about using it if they are having sex and they do not know the HIV status of their partner. They may not be in that position at that moment in time, but it is one that they could find themselves in at some point in the future.”
And to help improve take-up, in the spring Liverpool will launch women-only booking slots at their three clinics and this will be accompanied by a marketing campaign on PrEP in partnership with the council’s health promotion service Passionate About Sexual Health (PASH).
Women, alongside Black-African and trans and non-binary communities, are also a focus of Liverpool’s outreach work on PrEP. The outreach team works with a range of different organisations, including faith groups, charities that support sex workers, the local drug and alcohol team and ethnic minority community groups to run clinics in the community that offer HIV testing and PrEP as well as smear tests.
And later this year those pop-up clinics will be supported by an outreach bus that will provide a mobile service for the team.
Axess Assistant Divisional Director of Nursing Luke Byrne said: “It will be a great asset as it will allow us to go out into neighbourhoods and out to events and festivals and directly target key groups.
“The community pop-up clinics have worked really well. But they do require people to be there. With the mobile clinic for example we can go out to the neighbourhoods the sex workers are working in.
“We are also planning to take it out to events and festivals. People will be able to have HIV tests and get PrEP prescriptions – it should further help us engage those groups we are struggling to get to.”
Liverpool Director of Public Health Professor Matt Ashton is delighted with the work being done. “PrEP is a vital game changing drug that helps people maintain HIV negative status and we know access here in Liverpool has so far been very good.
“However, like many areas it has not been accessed by certain risk groups as well as others and equitable access to PrEP is important if we are to ensure we reach and achieve our zero new HIV transmissions target by 2030.
“The work Axess are doing here directly working with groups that are eligible, but so far haven’t accessed is excellent for the city of Liverpool and hopefully offers some best practice and a guide for others.”