Providing Oral PrEP: Month one

Good Support for Oral PrEP Adherence

By Alfred Itunga, Technical Communications Officer, LVCT Health
Starting a new routine in life is always difficult.

Participants of the LVCT Health demonstration project confronted a number of challenges when starting oral PrEP. LVCT adopted several strategies to help women adhere to oral PrEP despite challenges they might encounter.

“Beginning to take PrEP is a big challenge, because you may experience headache, stomach ache, vomiting and diarrhea.”
Valerie, project participant

These challenges range from stigma to hard-to-reach clinics. But in the first month of pill taking many women who started the project found side effects especially difficult.

“Generally, when you take any drug for the first time, there are people who experience side effects and there are people who do not experience side effects. The side effects that we had with PrEP during the first month of initiation like, general body discontent, we have nausea, general weakness of the body, these are mild effects that go within the first one to two week of taking PrEP.”
Maryanne Ajwang, clinical nurse at LVCT Health

PrEP initiatives should factor in ways of helping women get through this initial period, and supporting adherence to the daily pill, especially in the first month. LVCT Health learnt that most women were initially happy that they now had a prevention pill against HIV; however, the joy faded off quickly after they had started taking the pill and struggled with the side effects.

“We had people who dropped out because they could not bear the side effects and for them it was weight gain and feelings of lethargy and this lethargy was affecting their work.”
Matilda Abwok, LVCT Health researcher

To address this, and other challenges LVCT Health provided support at all times when women on oral PrEP needed reassurance. Staff made it easy to reach someone who would answer their questions. The project offered weekly meetings for women on oral PrEP to exchange information and share experiences.

“When you initiate someone in such a pill, you really need to give them a lot of education about that pill, what to expect, what to do when that happens, and how they can get to contact you if they have any problems? So that was my initial way of doing it. We exchanged contacts with the women.”
Maryanne Ajwang, clinical nurse at LVCT Health

LVCT Health established a free hotline for all the participants. They could call for assistance and guidance. The same person who attended them at the clinic answered their calls, building a relationship of trust. Staff found the participants responded well, they were open to sharing their experiences through the hotline.

Support groups played a key role in adherence. At weekly support groups, they discuss challenges and how they overcome them. Many women in the program pointed to the support groups as key to good adherence, helping them persevere despite the initial side effects.

“The support group really motivated me because this thing (oral PrEP) at the beginning, if you are not strong you can’t sustain [it]. Some people shared that they were okay while others said I have stomach aches, others headaches, so when I heard all those comments I said to myself, so it is normal, so after something like three weeks I became normal, just taking it and not feeling anything. I am okay.”
Monica, project participant

Other supportive policies included giving the participants priority when they visited the clinic, following up with the participants to find out how they were doing, and flexible clinic hours ensured that participants received the attention they needed to stick with oral PrEP.

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Additional Resources

  • To understand more about how support groups can help women persevere through the challenges of oral PrEP, click here
  • For oral PrEP communications materials, posters, provider training manuals and other oral PrEP resources from the LVCT Health IPCP demonstration project, click here
  • For oral PrEP training materials for providers, click here