Title: Development of an intervention to Optimise use of pre-exposure prophylaxis (PrEP) to prevent HIV-acquisition in at-risk individuals living in Wales [DO-PrEP]
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Approximately 157 individuals are diagnosed with human immunodeficiency virus (HIV) per year in Wales. Those infected experience a weakened immune system and eventually become unable to fight infection. Left untreated, HIV can be transmitted to others, and can eventually lead to the development of acquired immune deficiency syndrome (AIDS), where an individual’s immune system fails and they are prone to life-threatening opportunistic infections and cancers. Pre-Exposure Prophylaxis (PrEP, the use of antiretroviral therapy by HIV-uninfected individuals to prevent acquisition of HIV), is a proposed method of HIV prevention. Due to a lack of relevant evidence for individuals living in Wales, PrEP is currently being provided to eligible individuals for a three-year trial period through the NHS in Wales. As individuals may be at risk of HIV-acquisition indefinitely, and treatment is only required during periods of high risk, there is a need for a detailed understanding of how PrEP is used, and whether this use changes over time. For long-term availability of PrEP, further interventions may also be required to optimise its use in high-risk individuals. Aims: The overall aims of this work are to i.) Investigate the use of PrEP in people accessing it through the NHS in Wales; ii.) Evaluate existing interventions that aim to improve the use of PrEP for individuals at high risk of HIV acquisition; iii.) Explore the barriers and facilitators for the uptake and use of PrEP among those eligible to receive it through the NHS in Wales; iv.) Develop an intervention to improve the use of PrEP among those eligible to receive it through the NHS in Wales; v.) Understand ways in which the proposed intervention requires refinement prior to wider feasibility and pilot testing. Plan: The project is comprised of four Workpackages (WPs). WP1 is a seven-month observational study of 60 individuals accessing PrEP through sexual health clinics across Wales. PrEP use will be ascertained using electronic monitors. Sexual behaviour will be collected weekly via SMS text messages. WP2 involves a systematic review and meta-analysis of literature on existing interventions aiming to improve the use of PrEP for individuals at high-risk of HIV-acquisition. WP3 is a qualitative interview study of 20 to 30 individuals aiming to understand the barriers and facilitators of PrEP uptake and use through the NHS in Wales. WP4 will use the findings from previous WPs to develop and prototype an intervention. The work will conform to the intervention mapping protocol for developing theory/evidence-based behaviour change interventions. In addition: i.) a stakeholder panel will meet annually over the duration of the project to inform the design, interpretation and dissemination of research findings; ii.) the data from WP1, combined with contextual factors identified during WPs 2/3, will be used to inform the development of statistical methods for modelling adherence data that are fundamentally linked to risk coverage. Potential benefits: This work will provide high-quality evidence and novel insights into the use of PrEP across Wales. Alongside an intervention developed to meet the needs of PrEP users in Wales, this work will benefit individuals who are at high-risk of HIV-acquisition, sexual health clinics where HIV prevention strategies are generally provided, and Welsh Government policy makers considering the long-term availability of PrEP through the NHS in Wales.


Research activity codes: 4.3 INFLUENCES AND IMPACT;7.1 INDIVIDUAL CARE NEEDS
Health categories: INFECTION