Grant: HIV Implementation Science - Component 1

Canada continues to see unacceptable rates of incident HIV, particularly among gay, bisexual and other men who have sex with men. A new strategy called PrEP (pre-exposure prophylaxis, the daily use of anti-HIV medication by those at high risk) holds great promise to help address this challenge, and is already being prescribed by several HIV specialists in Canada. However, there are not nearly enough such specialists to meet the large and growing demand for PrEP. Further, reliance on these specialists is costly and detracts from their ability to care for people already living with HIV. In order for PrEP to have public health impact, we believe that PrEP delivery should be 'decentralized' by harnessing the skills of two existing sets of healthcare providers - family physicians (FPs) and sexual health clinic nurses. As a first step in our plans to achieve this vision, this proposal will evaluate the feasibility, acceptability and logistics involved in two corresponding interventions, each aimed at adapting PrEP delivery, as part of a combination HIV prevention approach, to a new practice setting. 1.We will empower patients to link their family doctors with online, evidence-based, continuing medical education resources on how to provide PrEP, using an innovative knowledge translation approach we have named 'Patient-Initiated CME' (PICME). 2.We will pilot the delivery of PrEP by nurses working in two of Toronto Public Health's sexual health clinics. We will evaluate the strategies by combining quantitative and qualitative data from several sources, including questionnaires we will administer to patients and their physicians at baseline and six months later; focus groups with patients, family doctors, nurses and other sexual health clinic staff; review of patient charts. Our findings will directly inform future plans to scale up these two approaches to other at-risk populations and other settings in Canada.