Missed opportunities for PrEP uptake Insights from a London e-service

25th September 2023 by Kate Ebbutt

Vanessa Apea,1 and Efejiro Ashano 1

1Preventx

Abstract Background

There is clear inequity in PrEP awareness, perceived candidacy and uptake, with predominant users in the UK being White men who have sex with men (MSM). Racially minoritised MSM and Black women (BW) are two key groups in which to maximise uptake to achieve 2030 targets. Users of an STI screening e-service, collaboratively funded by 30/33 London local authorities, are triaged to assess current PrEP use, HIV risk and PrEP eligibility.  If deemed eligible they are signposted to PrEP advice. We sought to quantify and characterise PrEPusers (PU) and non-PrEP users (NPU).

Abstract Method

We conducted a retrospective analysis of a London e-service, between April 2022 and April 2023, to explore the demographics of PU and NPU, focussing on MSM and BW, stratifying by age, ethnicity and HIV, Neisseria Gonorrhoea (GC) and Chlamydia Trachomatis (CT) positivity.

Abstract Results

100786 users who accessed the e-service for HIV testing were MSM; 47% (n=47568) were PU.  Of the 53218 NPU, 55% were signposted to PrEP advice. HIV positivity amongst NPU was slightly higher than PU, 0.32% versus 0.23%; the highest being amongst those of Latin American and other Black background. GC and CT positivity in PU were 8.3% and 7.49%, respectively, as compared to 4.9% and 4.39% in NPU. 64005 users were BW; only 38 were PU. Of the 63967 NPU, 30% were signposted to PrEP. HIV positivity amongst NPU was 0.29%; the highest amongst those of Black African background and those aged 25-34. GC and CT positivity in NPU were 0.5% and 3.51%, respectively.

Abstract Conclusion

The data offers insight into the potential magnitude and demographics of missed opportunities within HIV prevention. Future initiatives should further explore how to maximise PrEP uptake via digital PrEP pathways.