OPTIONS Tools & Resources
The US Agency for International Development’s (USAID) Office of HIV/AIDS is supporting five interconnected projects on ARV-based HIV prevention product introduction and access, the Microbicide Product Introduction Initiative (MPii) agreements, that run from 2015-2020. For further information on each project please click here.
Tools and resources from the OPTIONS Consortium (unless otherwise indicated) appear below. These materials range from literature reviews and analyses on ARV-based products, to country-specific situational analyses and oral PrEP rollout scenarios, to research presented at major conferences. Click on each header below for detailed explanations and links to the tools and resources.
PrEP Communications Accelerator: a digital demand creation tool for sub-Saharan Africa
Strategic communications are critical for successful market introduction of PrEP. The PrEP Communications Accelerator is a digital tool that provides communication strategies and tools for generating demand for PrEP across sub-Saharan Africa. It is the first demand generation tool focused on PrEP and can be used for any PrEP formulation.
- PrEP Communications Accelerator One-Pager
- PrEP Communications Accelerator Quick Start Guide
- [Webinar] Driving Demand for PrEP with the PrEP Communications Accelerator — download the slides or view a video recording
- "PrEP Communications Accelerator: A digital demand creation tool for sub-Saharan Africa" - appearing in Sexual Health
PrEP Costing Guidelines
The PrEP Costing Guidelines provide a framework for estimating the cost of providing pre-exposure prophylaxis (PrEP), which is the use of antiretroviral (ARV) drugs for preventing the acquisition of HIV infection. They are intended to provide a PrEP-specific resource for costing that could be accessible to individuals tasked with collecting, evaluating, and utilizing cost data, and who may have differing levels of familiarity with economics.
The PrEP Costing Guidelines have three principal aims: (1) Support the estimation of the full and incremental total cost and unit cost of adding PrEP to existing HIV or other health services; (2) Address some of the challenges faced by costing experts who are specifically assessing the costs of PrEP; and, (3) Improve the quality, interpretation and use of PrEP cost estimates through improved consistency and transparency of methods, assumptions and reporting.
Provider Training Package: Effective Delivery of Oral PrEP for Adolescent Girls and Young Women
The slides have been developed for all categories of healthcare providers involved in the provision of PrEP. The slides are adaptable depending on the participants and have been developed with this flexibility in mind. Please use the slide package as a guide and resource and adapt it to fit the needs of your country, participants and available time.
- Introduction — Provider Training Package: Effective Delivery of Oral Pre-Exposure Prophylaxis for Adolescent Girls and Young Women
- Module 1: Introduction to Oral PrEP
- Module 2: The Provision of PrEP in the Context of AGYW
- Module 3: Important Factors to Consider When Providing Oral PrEP to AGYW
- Module 4: Oral PrEP Provision for AGYW: Getting Started
- Module 5: Monitoring, Follow-Up and Adherence Support for AGYW on Oral PrEP
- Module 6: Wrapping Up
- Module 7: Addendum — Initiation and Clincical Management of Oral PrEP
The following attachments have been linked to in the training slides:
- Attachment 1: Introduction to the OPTIONS AGYW Training Package
- Attachment 2: Act Like a Man, Act Like a Woman
- Attachment 3: Group Activity: Exploring our Values
- Attachment 4: HIV Self-Perceptions of Risk and Attitudes toward AGYW
- Attachment 5: Tips for Conducting a Risk Assessment
- Attachment 6: Frequently Asked Questions (and Answers)
- Attachment 7a: Scenarios for Discussion
- Attachment 7b: Scenarios with Facilitators Notes to Guide Discussion
Reaching High Risk Women for PrEP: Learning from ARV-based HIV prevention trials
This study aims to apply the experience of clinical trial staff working in ARV-based HIV prevention trials and applying this programmatically to help identify and reach women most at risk for HIV with PrEP messaging. View a presentation on the findings.
Country Level Analysis: Situation Analyses, Landscape Analyses, Private Sector Analyses, PrEP Rollout Analyses, and Analyses Templates
Market research for different populations in Kenya provide key insights and communications implications for oral PrEP demand creation.
- Adolescent Girls and Young Women (April 2018)
- Men Who Have Sex With Men (July 2018)
- Female Sex Workers (July 2018)
- Key Insights and Communications Implications for Oral PrEP Demand Creation Among People who Inject Drugs in Kenya (November 2018)
- Key Insights and Communications Implications for Oral PrEP Demand Creation Among Serodiscordant Couples in Kenya (November 2018)
In August and September 2017, 670 people participated in 21 community dialogues in eight of Zimbabwe’s 10 provinces. Program designers engaged the participants in discussions about their perceptions of oral pre-exposure prophylaxis (PrEP) for HIV prevention and what they thought would encourage or discourage its use. The insights gained from these dialogues will inform the development of a comprehensive communications strategy to support the scale-up of oral PrEP in Zimbabwe.Download here.
The OPTIONS Consortium, with work led by FSG, recently created the Plan 4 PrEP tool to support national planning for oral PrEP rollout. The tool was developed based on experiences in South Africa, Kenya and Zimbabwe, where OPTIONS supported the Ministries of Health and technical working groups (TWGs) in each country to develop a strategy for oral PrEP introduction. For example, Kenya recently launched oral PrEP at a national level utilized these tools in supporting the planning.
The Plan 4 PrEP tool includes four steps. Implementers may use all four steps to guide the entire planning process or use only specific parts. Either way, this tool helps answer the tough questions that must be considered when preparing for oral PrEP introduction. The tool is particularly useful for policy makers, TWGs or others planning for oral PrEP introduction at the national or sub-national level. In addition, it’s a useful tool for implementing partners and advocates pursuing oral PrEP rollout.
Click here for an overview of the toolkit. A brief description of the four steps that comprise the planning process and links to the relevant tools are included below.
1. Situation Analysis: Understand what you are starting with as you prepare to offer oral PrEP.
In this step, identify existing assets, current gaps, challenges, stakeholders and key questions for oral PrEP rollout along the value chain. This is a good foundation for a comprehensive planning process.
2. Project Landscape: Assess findings and gaps in PrEP studies and implementation projects.
In this step, survey current and planned studies and implementation projects. These studies provide insights about how to successfully deliver PrEP to the populations who need it, but they are often uncoordinated. This provides a high-level overview of what is – and is not – being addressed in existing efforts on oral PrEP.
3. Rollout Scenarios: Decide where and how to roll out oral PrEP.
In this step, define scenarios for oral PrEP rollout in different counties/districts or to different populations. This simple analysis, based on existing data, can provide quick cost and impact comparisons to guide decision-making.
4. Readiness Assessment: Assess readiness for oral PrEP rollout.
In this step, assess readiness at the sub-national level to introduce and scale oral PrEP and inform planning for necessary investment.
If you would like guidance or instruction about how to use the Plan 4 PrEP tool, please contact us.
FSG, as part of the OPTIONS Consortium, reviewed existing publicly available literature and conducted interviews with relevant organizations to explore two major questions: to what extent does private sector health care reach women and girls at risk for HIV and what can be done to leverage this opportunity to deliver oral PrEP through the private sector.
The objective of this research, conducted in three OPTIONS priority countries, is to support planning by country governments, international donors and implementing agencies by better understanding the opportunities and considerations for delivering oral PrEP through the private sector.
The OPTIONS team (led by FSG in partnership with Pangaea Global and LVCT Health) produced an analysis of the rollout of oral PrEP in Zimbabwe and Kenya. These analyses examine a range of scenarios that differ by country and target population groups. Applying these analyses will inform planning for effectively delivering oral PrEP beyond demonstration projects. Further analysis planned for 2017 will build on this work, improving the field’s understanding of the following: capacity of specific countries to deliver PrEP, necessary costs, and comparisons of cost-effectiveness in different rollout scenarios.
These analyses explores two topics. First, they investigate which questions will be addressed by the current slate of ongoing or planned demonstration projects and which questions will remain unresolved. This will be used to make decisions about investments in additional research (if needed). This analysis also highlights when findings will become available to inform planning for PrEP rollout in these countries.
This research was compiled through a survey and a series of interviews with project leaders in these three countries.
The OPTIONS Consortium developed these situation analyses to capture the current state of progress toward the introduction of oral PrEP in Kenya, South Africa and Zimbabwe, and to identify key strengths, gaps and areas for consideration for planning and investment moving forward. The analyses, led by FSG in partnership with LVCT Health (Kenya), Wits RHI (South Africa) and Pangaea (Zimbabwe), was informed by research and interviews with in-country stakeholders and is organized along a simplified five-step value chain that comprises the core activities needed to introduce oral PrEP at the country level: planning and budgeting, supply chain management, delivery platforms, individual uptake and effective use and monitoring.
Communications and Implementation Materials from Kenya, South Africa and Zimbabwe
In an attempt to better understand how oral PrEP could be scaled up in Zimbabwe, a total of 21 community dialogues were conducted in five out of the ten provinces of Zimbabwe. Target populations included adolescent girls and young women, adolescent boys and young men, female sex workers, men who have sex with men, transgender populations, adult men, adult women, pregnant and lactating women, influential leaders, students in tertiary institutions, internally displaced populations and people living with HIV.
Key findings are presented in three main categories namely: community perceptions of oral PrEP; facilitators and barriers to PrEP uptake and adherence; and preferred service delivery models and communication channels for PrEP.
Related materials available on our Zimbabwe page.
The OPTIONS consortium supported the National Department of Health, South Africa, with the development of information, education and communication (IEC) materials for the launch of oral PrEP for female sex workers, men who have sex with men and university students. These materials were designed with inputs from local South African sex worker, MSM and youth programs. They have been well received by the target audiences.IEC for Sex Workers
The Introduction of Oral PrEP in Kenya
Kenya has been at the forefront of introducing oral PrEP. It has been the site of numerous demonstration projects, is currently hosting a large-scale implementation project called Jilinde, and in May 2017 initiated a nation-wide rollout of oral PrEP. The timeline below captures key milestones in the PrEP introduction journey in Kenya, and offers a window into the many challenges and successes along the way.
Kenya PrEP and Self-Testing Abstract Book
This abstract book brings together a wealth of information on the experiences, best practices and lessons learned from some of the PrEP and Self-Testing pilot and demonstration projects in Kenya. The main aim is to support national implementation of PrEP and HIV Self-Testing, by highlighting what has worked well and finding solutions for what may not have worked well.
Framework for the Implementation of Pre-Exposure Prophylaxis of HIV in Kenya
In May 2017, Kenya’s Ministry of Health introduced pre-exposure prophylaxis (PrEP) as an addition to existing HIV prevention interventions. This framework for implementation of PrEP for HIV in Kenya aims to provide guidance on the rollout of PrEP in Kenya. The target audience include policy makers, national and county governments, health program managers, regulatory authorities, health providers, potential PrEP users and the general population.
Kenya PrEP Communications Landscape Analysis
As the first step in a larger market preparation and communications plan, McCann Global Health (a member of the OPTIONS consortium) has conducted a landscape analysis of available information and knowledge on the demand creation and uptake of PrEP among vulnerable populations in Kenya, including serodiscordant couples, adolescent girls and young women, men who have sex with men, female sex workers and people who inject drugs. In addition to vulnerable populations, McCann also researched health care workers as the gatekeepers to HIV prevention products, services and information.
The objective of the landscape analysis is to uncover and/or confirm key findings, insights, tension points, gaps and needs for further investigation. Click below to view the full landscape analysis and the shorter gap analysis.
Literature Reviews and Summaries for Oral PrEP
Dapivirine Ring Resources
The common agenda is a shared guide for stakeholders working on the introduction of the dapivirine vaginal ring. The common agenda aims to keep stakeholders informed and engaged in a coordinated, efficient and transparent planning process for ring introduction leading to scale-up with the goal of streamlining and accelerating collective efforts.
The ring introduction matrix is an early-stage implementation tool intended to help policymakers and implementers consider the introduction of the dapivirine ring alongside oral PrEP.
The OPTIONS Consortium conducted secondary research and interviews with key stakeholders in several countries to understand questions about the ring that could inform demonstration and processes for introducing new biomedical HIV prevention products. Rwanda, Uganda, Kenya, Zimbabwe, Malawi, Tanzania and South Africa were prioritized for analysis due to the state of the HIV epidemic in each country and experience with ring trials. Interviews comprised a mix of policymakers, civil society representatives, donors, implementing partners and trial contributors.
Oral PrEP Provider Knowledge, Attitude and Practice Resources
Materials from other MPii Projects
Young women in sub-Saharan Africa have among the highest HIV incidence rates globally. However, in the context of placebo-controlled trials of oral and topical PrEP, young women have had lower PrEP uptake and adherence than others, making this population of particular importance. The POWER Study aims to characterize choice, uptake, early adherence and, through open cohorts in a demonstration projects, seeks to identify cost-effective and scalable delivery models to this key population.
Addressing Gender to Ensure Effective PrEP Introduction
As new HIV prevention methods are rolled out, women, girls, men who have sex with men (MSM), and transgender people will face barriers to product access and use that stem from cultural norms, lack of power in relationships and society, and limited access to resources. Gender analyses conducted in Kenya, South Africa, and Zimbabwe identified ways to address these potential barriers during PrEP introduction. Most critically, PrEP introduction plans must prioritize a rights-based, positive approach that normalizes use of the new products and makes them available to those who need them most. OPTIONS created a technical brief with recommendations for addressing these potential barriers.
This document, Engaging Male Partners in Women's Microbicide Use, aims to support effective male engagement in women’s microbicide use by:
- Proposing a goal, objectives, and an approach for male engagement in women’s microbicide use.
- Detailing clinic- and community-based programmatic strategies that would likely support effective men’s engagement in microbicides.
- Offering considerations for selecting, adapting, implementing, and evaluating proposed strategies.
- Addressing practical issues in male engagement in microbicides, such as intimate partner violence and how male engagement may differ depending on the type of microbicide formulation being introduced.
Posters and Presentations from MPii Projects
- Evaluating the Potential Impact and Cost-Effectiveness of Dapivirine Ring Pre-exposure Prophylaxis for HIV Prevention
- OPTIONS Plan 4 PrEP Learning Collaborative
- Health Care Workers’ Knowledge, Attitudes, and Practices Related to Oral PrEP Provision to Adolescent Girls and Young Women in Zimbabwe
- Creatively Empowered: The role of creative concept and IEC materials in influencing decision-making to use oral PrEP
- Understanding Service Providers’ Knowledge of Oral PrEP and Attitudes Toward Provision to Populations at Substantial HIV Risk in South Africa
- Health Care Providers’ Knowledge, Attitudes and Practices Towards Provision of PrEP to Adolescent Girls and Young Women in Kenya
- Delivering PrEP: Lessons from early demonstration projects
- The Dapivirine Ring: Key learnings from like-product introductions
- Risk Assessment Tools and the Identification of Individuals at High-Risk of HIV infection in the Delivery of Oral PrEP
- What is demand creation? (Briana Ferrigno)
- Demand Creation for HIV Prevention: A look back; a look ahead (Mitchell Warren)
- Insight Generation: What market research is needed for HIV prevention and how should it be used? (Michelle Risinger, Daniel Were)
- Communications Strategy and Tactics: How do we create desire for HIV prevention? (Annita Mondo, Hardwin Sithole, Briana Ferrigno)
- Media Mix: Media Planning Primer (Lucy Maikweki)
- Media Mix: How and where do we need to communicate? (Kimberly Green, Connie Celum, Georgia Arnold, Orode Doherty)
- Involving young people in rollout of oral PrEP: The case of Kenya
- Assessment of opportunities to deliver oral PrEP for women through private sector health care: Summary of research findings for ICASA 2017
- Pre-exposure prophylaxis implementation in South Africa: Overview
- Implementation of PrEP in Kenya: Ministry of Health
- The evidence base for women: World Health Organization
- Trust Issues: Perspectives of male and female partners navigating dapivirine vaginal ring (VR) use in dyadic relationships; formative research outcomes from the CHARISMA study in Johannesburg, South Africa
- Addressing Issues Impacting Safe and Consistent Use of an HV Prevention Intervention: Developing a Social Benefits- Harms Tool (SBHT)
- Who, Where, and How? Developing scenarios for the rollout of oral PrEP in Kenya
- Who, Where, and How? Developing scenarios for the rollout of oral PrEP in Zimbabwe
- Relationships Dynamics, Agency and Trust in the Context of Microbicide Use: Formative research outcomes from the CHARISMA study in Johannesburg, South Africa (CHARISMA, Poster)
- End User Research & Implementation Science to Facilitate PrEP Delivery from the POWER Study (POWER, Satellite Session Presentation)
- PrEP Market Shaping Communications in OPTIONS Countries (OPTIONS, Satellite Session Presentation)
- Tapping into the Unheard Voices of End-users to Deliver on Pre-exposure Prophylaxis (PrEP) for Adolescent Girls and Young Women (OPTIONS, Poster)
- Disclosure of Vaginal Ring Use to Male Partners in an HIV Prevention Study: Impact on Adherence (CHARISMA, Poster)
MPii Microbicide Stakeholder Updates
Last updated on April 8, 2019.