Developing the PATH-GP (Prevention and Testing for HIV in General Practice) intervention: a Person-Based Approach intervention development study to increase HIV testing and PrEP access

Background

Testing for HIV, linkage to treatment and access to pre-exposure prophylaxis (PrEP) (medication which reduces the risk of acquiring HIV) is essential for early HIV diagnosis, treatment, and prevention. General practice could play a key role in maximising H IV testing opportunities and supporting access to PrEP.

Aim

To develop an intervention for general practice to increase HIV testing and facilitate access to PrEP.

Design and setting

A person-based approach (PBA) intervention development study using the Capability, Opportunity, Motivation, Behaviour (COM-B) Model in South West England.

Method

A scoping review and semi-structured interviews with healthcare professionals (HCPs) and local organisation representatives with an interest in HIV prevention/healthcare) were conducted to understand the challenges and find potential solutions to increase HIV testing and facilitate access to PrEP in general practice. Intervention development used focus groups with HCPs and the public. Purposive sampling ensured diversity of practices and participants. Data was analysed using the PBA table of planning and CLIP-Q approach.

Results

Barriers identified included lack of clinician knowledge of HIV and PrEP, concern about stretched resources and a lack of systematic testing methods. Proposed strategies included simpler testing methods to normalise testing and reduce HIV stigma. The intervention developed consists of: education, a prompt to test, simplified and standardised testing and PrEP signposting processes, patient information, and practice champions.

Conclusion

Research is needed to explore the feasibility and the effectiveness of this multicomponent intervention to increase testing and access to PrEP within general practice. Funding barriers also need to be addressed.

How this fits in

• General practice could play a key role in maximising HIV testing opportunities and supporting access to pre-exposure prophylaxis (PrEP). Opportunities to carry out HIV testing continue to be missed in general practice leading to late HIV diagnosis which is associated with reduced life expectancy, increased mortality and greater treatment costs.

• Patient acceptability for HIV testing is high but testing rates are low and variable and patients experience barriers to accessing PrEP through sexual health clinics.

• This research reports the development of a multi-faceted approach to increase HIV testing and access to PrEP in general practice using the person-based approach. This included investigating public and healthcare professional perceptions about a range of approaches including training, opt-out testing, and the provision of decision-making aids.

• Targeting capability, opportunity and motivation barriers the intervention encompasses HIV and PrEP education and training, and the provision of simpler and systematic approaches to testing.