PrEP and telemedicine in times of COVID-19: experiences of health professionals in Mexico

BACKGROUND: ImPrEP Mexico was a pre-exposure prophylaxis (PrEP) demonstration project offering PrEP for populations at high HIV risk. To provide continuity of PrEP services during the first year of the COVID-19 pandemic, telemedicine strategies were adopted to reduce face-to-face on-site attendance and risk of contagion. This study's goal was to document experiences and lessons learned among ImPrEP health professionals using tele-counselling, as to determine the acceptability of such strategies and the willingness to continue to use them post-COVID19.
METHODS: In May 2021, we conducted 16 online interviews with health professionals from the 4 ImPrEP implementation sites located in Mexico City, Guadalajara, and Puerto Vallarta. We used a semi-structured interview guide to explore the seven dimensions posed by the Theory of Acceptability (affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy). Interviews were audio recorded, with prior informed consent, and were subsequently transcribed and coded using the software Atlas.ti.
RESULTS: All the interviewed professionals had carried out telemedicine strategies. Their experience was mediated by the pandemic context, available technological infrastructure and logistics, as well as by their personal disposition, attitudes, knowledge and previous experience. They perceived this strategy as appropriate strategy for specific user groups. They perceived benefits from telemedicine such as the reduction of the risk of COVID19-infection and the diminished time in terms of transfers, duration of sessions and waiting times. Amongst its barriers, they mentioned the impossibility of physical examinations and the difficulty for users to acquire medicines using prescriptions received electronically. They also perceived that the implementation could lead to economic, work, and emotional burdens, may violate personal privacy, and can hinder the therapeutic relationship.
CONCLUSIONS: Telemedicine strategies are a tool that can facilitate PrEP access for specific groups of users (e.g., with telephone access). It is necessary to consider it as a complement or as part of a hybrid model alternating both face-to-face and virtual care . To enhance benefits and guarantee success, requirements include clear implementation guidelines, providing up-to-date electronics devices, guaranteeing adequate Internet connectivity and infrastructure, and strengthening the skills of professionals and users for using this form of care.

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