The first study by Kwon et al. looked at POC testing for PrEP and whether this could be implemented to reduce the barrier to entry of cost and appointment time / inconvenience for the at risk MSM community in Hong Kong. As a consequence of the study the clinicians were able to maintain a reasonable clinic visit time of 30 minutes (of which 20 minutes was for rapid HIV / BBV / creatinine testing) with confirmatory 4th generation serology for HIV and other more established PrEP investigations at each visit. The patients were then able to also collected and a plan to contact if this was abnormal. Additional sexual health screening was also performed in parallel including creatinine estimation, HBsAg and syphilis as a point of care test.
Whilst as a clinician working in Australia, we take for granted the near universal availability of PrEP to those at risks, and it was interesting to hear how even in high income countries like Taiwan and Hong Kong, there is still little if any publicly funded schemes. Although patient sourced PrEP has increased to cope with the needs of the key populations in the absence of this despite these proactive patients, the 90-90-90 goals will remain a challenge without also utilizing the role of PrEP in preventing new infections and helping curb epidemic spread. It is encouraging that this study has received further funding to roll out the program more widely now. Streamlining new PrEP patient’s clinic experience a single visit potentially resulting in a prescription is a step in the right direction.
My main take home was reflecting on how this might potentially facilitate my own prescribing and monitoring of PrEP; having point of care testing kits may reduce the need for visits for blood / urine testing in low risk individuals prior to an appointment for a prescription, which may make it easier and more inviting for patients seeking PrEP to seek it out through our existing medical model. In my opinion, clinician delivered PrEP (primarily via a GP or sexual health specialist) remains superior, at least in Australia, as we can use this for opportunistic health interventions that may be missed with patient sourced PrEP. The use of such POC testing with protocol driven prescribing does potentially also open the door for a relative demedicalisation to a nurse led model, which was presented as having been trialed in NSW, however it is unclear how this would work within the Medicare reimbursement system as it exists just now. As Australia continues to make inroads in stemming and reversing the HIV epidemic it is also helpful to remain informed and abreast about our regional community as in our age of low cost rapid international travel we have to accept we do not live in isolation; furthermore it is exciting to think of all the frontiers this battle is being fought on, not simply in traditional European/American/Australasian institutions or pharmaceutical companies but also in all the global cities of the world, reminding us this disease does not discriminate against race.
Author bio: I am a small clinic owner in private GP practice and am passionate about providing the best care for all our patients; to this end we have developed a focus on immunology and infectious diseases and I am an S100 prescriber. We eradicated all known cases of HCV in our practice last year and proactively advertise testing for this. I am a member of the Perth S100 HIV and viral hepatitis networks as our clinic are regular attendees at the Perth Transgender network meetings. I remain invested in our future colleagues as a clinical lecturer at two Perth-based medical schools, having taught or hosted in clinic 10-20 students per year, and also as a part time employee with WAGPET where I am a regional medical educator for Perth Inner Metro and Fremantle. I was also fortunate enough to be honored to be awarded the 2019 WA GP of the year.
