HIV

Increasing Uptake of PrEP Report

The English HIV and Sexual Health Commissioners’ Group (EHSHCG) have launched their HIV PrEP insight report outlining new insights about the barriers and facilitators to increase the uptake of PrEP amongst underserved populations in England.

Working with a diverse range of community stakeholder organisations across England, EHSHCG appointed Hitch Marketing in 2022 to help to address a gap in understanding how PrEP uptake could be improved. The EHSHCG and commissioners across England have observed largely a strong demand of PrEP since it became part of routine commissioning in 2020. This is particularly true of Gay and Bisexual Men who have sex with Men. However, for other groups who can experience poor HIV and sexual health outcomes, PrEP uptake was much lower, potentially deepening health inequalities. This research focussed on Black African women, Trans and non-binary people and sex workers (women or trans or non-binary).

EHSHCG took a behavioural insight approach and invited Hitch to focus on system and organisational behaviours, as well as those of individuals.  The approach taken by Hitch was to build capacity amongst grass-roots community organisations who had trusted relationships with the audience. These organisations conducted qualitative research with the key audiences using peer, community and 1-2-1 focus groups. The report reveals deep conversations, reflections, contradictions and needs for all groups.

The results outline barriers experienced by each group, but also offer a range of facilitators. The recommendations are then mapped against personal, provider, and wider system domains. This means that there are recommendations and findings for policy makers, clinicians, commissioners, and community-based organisations as well as all others in the sector.

For example, some results show that when addressing psychological capability, and seeking to increase awareness and knowledge of PrEP:

Personal: 

• Targeted awareness campaigns or initiatives (e.g., train-the-trainer type programmes) encouraging and equipping people with the knowledge, skills and confidence to speak about PrEP to others.

Provider: 

• Healthcare professional training and resources on PrEP, including how and when to discuss PrEP, how to refer to the next step, how to ask questions related to sexual history/partners for a diverse range of audiences.
• Greater outreach activity in key settings to promote information about sexual health services and PrEP.

System

• Information about PrEP available from one trusted source (e.g., NHS website), that appears at the top of search engines, links to other organisations for specific information relevant for diverse audiences. Information on other forms of protection, should include a link to PrEP information.
• Tools to understand if PrEP is for you and to assess risk much more widely promoted, such as IwantPrEP now PrEP tool.[1]
• Information in locations/settings/websites/apps audiences already access/use (e.g., pharmacies, GPs, settings relating to reproductive health, women’s organisations, grassroots organisations etc.).

Please read the full report for more important insights.

Improving access and delivering PrEP equity for those who are eligible, irrespective of sex, gender, ethnicity, disability, geographic area of residence of socio-economic background is critical to achieving the HIV Action Plan in England. The group invites stakeholders to use the findings in this report to support future approaches to PrEP and ending new HIV transmissions.

Thanks to everyone who participated and informed this research, including:

• Yorkshire MESMAC
• BHA for Equality
• Basis Yorkshire
• Mojatu
• The Eddystone Trust
• Portsmouth City of Sanctuary
• PrEPster
• Indigo Gender Service
• Vista

All particular thanks the team at Hitch for the excellent work and dedication, particularly Saoirce and James.