PrEP Use, Sexual Behaviour, and PrEP Adherence Among Men who have Sex with Men Living in Wales Prior to and During the COVID-19 Pandemic.

We examined PrEP use, condomless anal sex (CAS), and PrEP adherence among men who have sex with men (MSM) attending sexual health clinics in Wales, UK. In addition, we explored the association between the introduction of measures to control transmission of SARS-CoV-2 on these outcomes. We conducted an ecological momentary assessment study of individuals in receipt of PrEP in Wales. Participants used an electronic medication cap to record PrEP use and completed weekly sexual behaviour surveys. We defined adherence to daily PrEP as the percentage of CAS episodes covered by daily PrEP (preceded by ≥ 3 days of PrEP and followed by ≥ 2 days). Sixty participants were recruited between September 2019 and January 2020. PrEP use data prior to the introduction of control measures were available over 5785 person-days (88%) and following their introduction 7537 person-days (80%). Data on CAS episodes were available for 5559 (85%) and 7354 (78%) person-days prior to and following control measures respectively. Prior to the introduction of control measures, PrEP was taken on 3791/5785 (66%) days, there were CAS episodes on 506/5559 (9%) days, and 207/406 (51%) of CAS episodes were covered by an adequate amount of daily PrEP. The introduction of pandemic-related control measures was associated with a reduction in PrEP use (OR 0.44, 95%CI 0.20-0.95), CAS (OR 0.35, 95%CI 0.17-0.69), and PrEP adherence (RR = 0.55, 95%CI 0.34-0.89) and this may have implications for the health and wellbeing of PrEP users and, in addition to disruption across sexual health services, may contribute to wider threats across the HIV prevention cascade.

Implementation and evaluation of telemedicine consultations in sexual health during COVID19: Service evaluation and prospective patient feedback

Introduction: COVID19 has led to closure of traditional walk in sexual health services. Clinicians using telephone consultations may miss non-verbal cues such as changes in body language. NHS Wales procured video consultation (VC) software which was implemented in our clinic. We present service evaluation and patient feedback from this. Methods: We searched electronic patient records for VC attendance codes. Patients undergoing VC were invited by SMS after consultation to complete an electronic patient satisfaction survey. They rated different elements of the experience using Likert scales and could leave additional feedback. Results: Between 04/04/2020-17/07/2020, 227 patients had VCs;105 were new and 115 were follow ups. The median age was 33 ranging from 15-78 years and 102, (45%) were male. Consultations were mostly for GUM 123 (54%) but also SRH (16%), HIV (16%), PREP (6%) and counselling sessions (9%). 62 patients (27%) completed the survey. 44% were aged 25-34. 35% of the survey responders had accessed clinic for SRH purposes only. 85% were 'very satisfied' when asked about the overall VC. 89% were 'very happy' with the length of time spent with the practitioner and 89% felt 'very happy' that their privacy had been respected. 98% said that they would use it again and 98% would recommend it to a friend. In the freehand section, the overall individual feedback was positive including from vulnerable groups in our local population. Discussion: VC has been used extensively in our integrated service and has allowed the service to manage demand and maintain quality during the COVID19 pandemic. The participating service users match our local patient demographics. The VC experience was highly satisfactory to those who responded to the survey. Although the use of VC will not be possible for all, this service enables us to prioritise those groups who need face to face contact whilst maintaining social distancing.

Maintaining and sustaining open access PREP behind closed doors - Development of an online service to minimize COVID19 risk to patients and healthcare workers whilst providing HIV prevention to people at risk

Introduction: In Wales, PrEP has been freely available for at risk groups such as MSM and trans people since 2016. Despite lockdown measures, casual sex continued for some causing concern about HIV acquisition. Due to a need to reduce face to face visits and provide a service following clinical staff redeployment to COVID wards, the service developed a new model for PrEP provision. Postal kit testing for HIV became available in Wales regardless of age or risk and this provided an opportunity to integrate these services and provide remote PrEP services. Methods: We examined clinical information, attendance and prescribing data collected from EPR during the COVID19 outbreak and compared with 2019. Results: Between 01/02/2020-01/04/2020, 186 attended the PrEP service in anticipation of lockdown compared with 111 in 2019. During this period six monthly PrEP was issued with advice to switch to event based dosing where possible. Between 01/04/2020-17/07/2020 93 patients went through the virtual clinic where care was provided by video and telephone consultations and postal kit tests for HIV and renal function compared with 283 in the same period in 2019. 1 used the pharmacy home delivery service whilst all others preferred to pick up PrEP at the clinic pharmacy. 1 patient known to the PrEP service did not access the clinic for further prescriptions during lockdown and seroconverted as lockdown eased. Discussion: Many people changed sexual behaviours early in the COVID pandemic, yet acute HIV infection was diagnosed in our cohort despite advice to avoid sex with casual partners during the lockdown, highlighting the importance of maintaining provision of HIV biomedical prevention services. PrEP services can be safely delivered outside of the traditional face to face setting via remote or online clinics. These models could also be applied outside of the pandemic to improve access in a format that some patients prefer.