Improvement in HIV PrEP offer to eligible patients accessing the Integrated Sexual Health (ISH) service at CNWL

Dr Arthur Wong who won Best Trainee Award at the CNWL Safety Conversation Day for his and his team’s improvement project talks about their work to improve the HIV PrEP offer to eligible patients accessing the Integrated Sexual Health (ISH) service at CNWL.

We knew we had a problem with offering PrEP to eligible men who have sex with men (MSM).  As a starting point we collected baseline data and found that current uptake of PrEP was just 78%.  Based on the most current evidence we knew we needed to improve the offering and the uptake. 

We iteratively tested many change ideas through PDSA cycles, which helped us understand what worked well and what we needed to adapt.  Based on this we found that reminding staff to offer PrEP was one of our most promising change ideas. 

We did this through setting up a reminder prompt in our electronic patient record system, sending individual reminders to staff and we also held daily clinic huddles where PrEP was on the agenda. 

Through these reminders and other change ideas, we improved the percentage of MSM who were both offered and accepted PrEP from 78% to 95-100%.  

A part of the project that I really enjoyed was getting the whole team’s input.  I think this was central to the success of the work. The project team also fed back that 

"We have learned throughout this QI Project the importance of providing a variety of teaching environments in order to empower our staff to feel confident offering & commencing someone on PrEP. We deliberately catered to a range of staff groups using a variety of modes of delivery (from 1:1, to small groups to whole-service teaching) so no one feels left out." 

Going forward we want to build on this and explore the barriers and leavers to PrEP uptake with the people who use our service. 

Since creating our poster, we have continuously measured our outcome and found we have sustained our improvement. 

If you would like to know more specific details about this project then please email us at cnw-tr.improvementsupport@nhs.net and we will be very happy to connect you with Dr Arthur Wong.