A programme to distribute and prescribe a revolutionary medicine to reduce HIV transmissions in Glasgow for people who inject drugs has been featured as an example of good practice in integrated working in a national HIV Journal, HIV Medicine. 

Pre-Exposure Prophylaxis, PrEP for short, is a medication that can be taken by anyone who is HIV negative to lower their risk of acquiring HIV infection. PrEP can be taken by HIV negative people before having sex (pre-exposure) to prevent infection (prophylaxis). PrEP is for anyone irrespective of their gender and sexuality. 

Oral PrEP is currently available for individuals at sexual risk of HIV through NHS Greater Glasgow and Clyde’s (NHSGGC) Sandyford Sexual Health Services hosted within Glasgow City Health and Social Care Partnership (HSCP). However, uptake by people who inject drugs (PWID) has been negligible. 

Aiming to increase the uptake of the medication with PWID in Glasgow, Sandyford staff worked with our HSCP’s Homelessness and Addictions Services to provide a tailored outreach PrEP service based in Glasgow’s Homeless Health Centre. This adapted model allows this group of people with complex needs to get information about HIV prevention methods, education on HIV and equitable access to PrEP medication.

Becky Metcalfe, Consultant in Sexual Health and HIV and Clinical Director at the Sandyford Sexual Health Service said: “A few years ago, in the midst of an HIV outbreak in Glasgow, Sandyford staff started to work with Homelessness and Addictions Services to achieve equitable PrEP access for people who inject drugs as one part of our many interventions and harm reduction measures. 

“In this evaluation, we reviewed the case records of all PWID identified by the outreach team as being at higher risk of sexual acquisition for whom PrEP was considered between November 2018 and November 2020. Evaluation focused on PrEP uptake, adherence and monitoring. We conducted a descriptive statistical analysis. Results showed that the service was feasible to run, but it relied on outreach provision and liaison with other services.

“We used active case finding, flexibility of assessment location, supervised community daily dispensing and active follow-up to optimise uptake and adherence. A two-year service evaluation showed that tailored PrEP services can reach PWID effectively. Uptake and adherence were high but the model was resource-intensive. Appropriately tailored PrEP delivery may be required to meet the needs of this and other key populations who experience barriers to accessing mainstream services.”

The service assessed 47 PWID who were at risk of HIV via sexual exposure, of which 78% started taking PrEP. Taking the medication every day (adherence) is crucial and the team worked with community pharmacies to give PrEP alongside Opiate Substitution Therapy (OST). Information on adherence to the medication showed that PrEP was taken on 97.6% of days it was prescribed.   

Rhoda MacLeod, our HSCP’s Head of Adult Services (Sexual Health and Police Custody and Prison Health Care) said: “This is a really good example of integrated working between our Sexual Health, Homelessness and Addictions Services and shows how by working together we can make a real difference to health and wellbeing of our most vulnerable people.”