Beyond the Clinic is a new study from the SHARE collaborative exploring the potential for equitable implementation of long-acting injectable cabotegravir for PrEP outside of sexual health clinics among PrEP providers and potential PrEP providers in the UK.
Pre-exposure prophylaxis (PrEP) is a highly effective medication that HIV-negative people can take before and after sex to reduce their risk of getting HIV.
Until now, PrEP has only been available in the UK as a pill, taken daily or before and after sex. However, long-acting injectable cabotegravir (CAB) for PrEP has very recently been approved for NHS provision in Scotland and is currently undergoing assessment for provision in England and Wales.
CAB for PrEP is an intramuscular injection taken once every two months. It has been shown to be very effective at preventing HIV as people find it easier to adhere to than taking oral pills every day. People may also prefer CAB for PrEP as it is more discreet than carrying pills. Women have especially been found to prefer CAB for PrEP over pills.
Currently PrEP is only available from NHS sexual health clinics in the UK. However, some people may find it difficult to access PrEP because of the stigma associated with using sexual health services and this can increase health inequities.
Women, heterosexual men, racially minoritised communities, trans and gender diverse people and young people are less likely to take PrEP. Making PrEP, including CAB for PrEP, available in other settings outside of sexual health clinics (such as pharmacies, GP practices and third sector organisations) could make accessing PrEP easier for them.
We want to understand what current and potential PrEP providers think about the feasibility of delivering CAB for PrEP in clinics and in alternative settings, such as pharmacies, GP practices and drug and alcohol services. This will include exploring what the barriers are to implementing PrEP beyond the sexual health clinic.
We also want to understand how they think this might improve equitable access to PrEP, including CAB for PrEP.
The information we gather will help us to develop recommendations on ways to optimise implementation of CAB for PrEP so that PrEP uptake and use is more equitable across all the groups who may benefit from it.
We will share our recommendations with policymakers, commissioners and service providers with the hope of influencing how CAB for PrEP is delivered in the UK.
The Beyond the Clinic study has three phases. Each study phase will be informed by the previous one.
First, interviews with current PrEP providers (i.e. sexual health clinicians) will help us to understand the topic in more depth and identify the best survey questions to ask sexual health clinicians about implementing CAB for PrEP beyond the clinic.
Second, a brief survey will be sent to all sexual health clinics in the UK to understand the breadth and scale of the issues which may impact equitable implementation of CAB for PrEP beyond the clinic in the UK.
Third, interviews will be conducted with potential PrEP providers in alternative settings, such as pharmacists, drug and alcohol service providers and GPs, to understand the issues from their perspective.
The Principal Investigator for the study is Dr Sara Paparini. The other study team members are Prof Chloe Orkin, Dr Melanie Smuk, Rosalie Hayes and Nishat Halim.
SHARE has a paid community advisory board of people living with HIV who provide strategic oversight and guidance on all our studies.
In addition, the Beyond the Clinic study has an Expert Advisory Group whose will provide advice and guidance to the study team. Our EAG members are:
This study is being funded by Viiv Healthcare.
