HIV prevention and testing in general practice

The UK Government’s goal of ending new HIV infections in England by 2030 requires better HIV prevention, detection and treatment. Patients with HIV often present to their GP several times with signs, symptoms or a diagnosis more commonly found in those with HIV before being diagnosed, but healthcare professionals (HCPs) often miss the opportunity to test for HIV. PrEP (pre-exposure prophylaxis - the use of anti-HIV medication to reduce the risk of acquiring HIV) is available for free on the NHS via sexual health clinics. It is predominantly accessed by white British, male, men-who-have-sex-with-men suggesting other groups at increased risk of HIV face barriers to access. Increasing access to PrEP through general practice by identifying eligible patients and referring to specialist services could help address this issue.

Aim: To use the Person-Based Approach (PBA) to develop a general practice intervention to increase HIV testing and support access to PrEP. The PBA incorporates user-centred design, behaviour change theory and iterative mixed methods research to investigate attitudes, needs and the context of target users to develop behavioural interventions that are persuasive, and successful.

Objectives: 1) to analyse evidence on the effectiveness and barriers and facilitators of interventions to increase HIV testing and support PrEP access in general practice; 2) to examine the facilitators and barriers to increasing HIV testing in general practice; 3) to examine barriers and facilitators to general practice HCPs supporting access to PrEP; 4) to develop guiding principles to summarise the core objectives and features of an intervention; 5) to build a logic model; 6) to refine the guiding principles and co-develop intervention content.

Methods:

Objective 1: rapid scoping review of existing evidence.

Objective 2: qualitative semi-structured interviews with HCPs in GP practices with low and high HIV prevalence in Gloucestershire, Bristol, North Somerset and South Gloucestershire and, Bath and North East Somerset will examine the facilitators and barriers to increasing HIV testing and accessing PrEP in general practice. This evidence will be used to develop guiding principles and a logic model (Objective 3 & 4).

Objective 5: PPI Public Advisory Group (PAG) and Clinical Advisory Group (CAG) workshops and think-aloud interviews with HCPs will co-develop and refine intervention content.

PPI: Patients and HCPs support the need for this research, have been involved in the study design and two patients are collaborators. The PAG and CAG will participate in workshops to design intervention content. PPI members will help develop study materials, interpret findings, develop intervention content, co-write publications and support dissemination.

Outputs: Academic publications, establishing topic expertise within SPCR, and reports for stakeholders. The results of the study will inform the sexual health strategy across three Integrated Care Systems. Funding will be sought to pilot test the intervention.

Amount Awarded: £58,401