P315 Increased clinician confidence and uptake of event-based PrEP by men who have sex with men during the COVID-19 pandemic

ABSTRACT

BackgroundHIV pre-exposure prophylaxis (PrEP) is an effective, safe strategy to prevent HIV. PrEP can be used either daily or as an event based dosing (EBD) regimen by men who have sex with men (MSM) having condom-less anal sex, however clinicians with expertise delivering daily PrEP often lack confidence delivering EBD-PrEP. During the COVID-19 pandemic, MSM appear to have tailored their sexual behaviour in-line with local social restrictions including the way they use PrEP.MethodWe aimed to investigate the proportion of MSM using EBD-PrEP between October-December 2020 and to survey clinician confidence in delivering EBD-PrEP through an online questionnaire.Results551 MSM were seen who were eligible for PrEP in the study period, of which 448 were prescribed PrEP (64-declined, 2-stopped, 8-new patients and 29-repeat attenders accessed PrEP from another source). The median age of PrEP users was 37 years (IQR=29–48). Overall, 94/448 (21%,95%CI=17–25) of MSM were using EBD-PrEP. New starters were significantly more likely to use EBD-PrEP compared to existing PrEP users (34%.v.13%, χ2=27.6, p<0.00001). There was no significant difference in age between daily and EBD-PrEP users (37years. v.41years,p=0.2). There were 33/38 clinicians who responded to the online survey. Clinicians felt equally confident at delivering daily PrEP as EBD-PrEP (Likert scores=4.4/5 v 4.2/5, p=0.2). However, potential barriers identified to providing EBD-PrEP by clinicians were;assessing which MSM would be suitable for using EBD-PrEP, having access to appropriate information for patients to support their understanding of using EBD PrEP;and clinician knowledge and belief in the efficacy of EBD-PrEP.ConclusionThe uptake by MSM and clinician confidence in discussing EBD-PrEP appears to have increased since the start of the COVID-19 pandemic. Giving MSM greater choice in how PrEP is used will optimise its effect on reducing HIV transmission. More research is needed to support both MSM and clinicians to deliver EBD-PrEP.