Background: Providing universal access to PrEP across Queensland, the 2nd largest and 3rd most populous state in Australia has provided unique challenges. Queensland has 22.5% of Australia’s total land area, compared to the 14.4% of New South Wales, Victoria and Tasmania combined. Queensland is also less centralised with 50% of the population living outside the state capital and 25% outside of the south eastern region. Notably, this population distribution is reflected in HIV diagnoses with 24% of new diagnoses in 2015 coming from Health Service Areas outside of the south east.
Method: The unique service models, buildings, personalities, communities and clinical capacity of regional services has required bespoke solutions to implement QPrEPd in these sites. Many sites have not taken part in clinical trials before and required additional support. Additionally, the barriers to access found in more conservative services and communities has required the implementation team to advocate and educate for universal PrEP provision. Protocol modification has enabled nurses to manage ongoing PrEP provision in services with limited medical officer support.
Results: Eleven study sites are outside of the south east corner; 7 public sexual health services, 3 general practices in Cairns and one Aboriginal Medical Service in Toowoomba. These sites have enrolled 18.5% of the all participants. The remaining 11 sites in the south east corner are include 5 general practices, including one run through a community based organisation, 5 public sexual health clinics and one private hospital. Overall, nearly 63% of the participants have enrolled at general practice sites.
Conclusions: While this project has provided access to PrEP throughout much of Queensland, gaps remain. The key limitation in regional areas where there is no public sexual health service is the lack of S100 prescribing general practitioners. In order to expand access other service delivery models are being explored
