Oral Abstracts

<b>Background</b>:<br/>Oral PrEP is central to HIV transmission elimination, but ongoing provision can be burdensome for users and puts strain on services. While online provision could help address challenges, there is little published evidence regarding online PrEP services’ development, evaluation, and economic considerations. Following rigorous development, we conducted a study to determine the feasibility, acceptability, and economic consequences of providing PrEP through the ePrEP Clinic: a digital clinical care pathway for established users, integrated within NHS sexual health services (Figure 1).<br/><br/><b>Method</b>:<br/>We recruited PrEP users with standard monitoring needs from Scotland's largest sexual health service (11/2024-08/2025). The ePrEP Clinic replaced one standard follow-up PrEP appointment. In addition to a self-sampling kit (SSK) and asynchronous online consultation (AOC) (Figure 1), participants provided baseline demographics and completed an end-of-study acceptability questionnaire. We captured detailed healthcare resource utilisation data.<br/><br/><b>Results</b>:<br/>81 people (median age 32 years, 95.1% male, 85.2% gay, 7.4% transgender) started the ePrEP Clinic pathway, 75 (92.6%) of whom completed HIV/STI testing and the AOC. 72 (88.9%) received PrEP through the ePrEP Clinic (2 had sufficient supply, 1 did not collect). 41 (50.6%) required at least one user-initiated (e.g. new SSK request) or clinician-initiated (e.g. checking newly prescribed medications) ‘support interaction’. 12 (14.8%) required in-clinic testing.<br/><br/>All 60 acceptability questionnaire respondents rated their experience as satisfactory/very satisfactory. 53 (88.3%) found the ePrEP Clinic more/much more convenient than standard care. Participants felt the ePrEP Clinic overcame barriers including challenges booking/attending scheduled in-clinic appointments.<br/><br/>Participants had more unplanned clinic attendances in the three weeks after using ePrEP Clinic (9) than after a comparative follow-up a year prior (5). Factoring in these unplanned attendances, the ePrEP Clinic released 1463 minutes of clinical time across 81 participants.<br/><br/><b>Conclusion</b>:<br/>This is the first study to comprehensively consider the potential impact of digital PrEP services. The ePrEP Clinic appears feasible and acceptable, substantially reducing the clinical time required per user. Clinical support was essential despite rigorous pre-study development and NHS integration, highlighting the need for adequate clinical support for digital services. Moreover, the subsequent unplanned clinic attendances require further exploration.<br/>