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-it

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Governments, donors and other stakeholders in countries at the forefront of oral pre-exposure prophylaxis (PrEP) delivery have encountered several programmatic challenges such as difficulty in setting targets, tracking the continuum of PrEP delivery, and estimating program costs and impact.

PrEP-it, a Microsoft Excel-based tool for oral PrEP implementation planning, monitoring and evaluation, can help! Visit here for much more, including a user guide, tutorial videos, an example worksheet and the tool itself.

Advancing PrEP: Comprehensive and Combined Evaluation of Services for Sex Workers and MSM (ACCESS)

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A collaboration between the South Africa NDOH, OPTIONS Consortium and Prevention Market Manager, this study aimed to examine factors affecting clients’ decisions to initiate, continue and/or stop PrEP use; assess service provider knowledge, attitudes, and behaviors around oral PrEP delivery; and, examine the effectiveness of oral PrEP marketing and communication mechanisms.

Resources:

ACCESS Blogs:

Behind the Scenes: what clients and health providers really think and feel about oral PrEP uptake and continuation

October 2019

This blog series translates the ACCESS study results into easy to read, fun and informative articles. ACCESS was developed to understand why people chose to use oral PrEP for HIV prevention, what motivated them to continue using it and if they stopped, why they decide to do so. The study also aimed to understand how much health providers know about oral PrEP, as well as to get insights into their opinions and experiences with providing oral PrEP to their clients.

  • Oral PrEP – The pill with a big heart
    This blog is the first in the ACCESS blog series and it gives an overview of the study findings. It explores the motivations that made clients decide to start, continue or stop using oral PrEP, as well as what made certain clients decide not to start taking oral PrEP at all.
    Read more.
  • Slaying Side Effects – It’s all about managing the menace
    This narrative focuses on PrEP-related side effects. It highlights the determination of some clients to continue using oral PrEP despite the side effects they were experiencing.
    Read more.
  • Oral PrEP Health Providers Have Their Say – Opinions, thoughts and experiences
    The third blog in the series addresses health providers’ experiences with oral PrEP services. It explores their knowledge of oral PrEP and concerns about increased risky behaviour. Health providers also expressed concern about the challenges clients faced when accessing oral PrEP and the barriers to uptake, adherence and continuation.
    Read more.
  • Wrapping It Up – PrEP as part of combination prevention
    This installment wraps up the series and talks about combination prevention, particularly the effects of oral PrEP use on condom use.
    Read more.

OPTIONS HIV Prevention Ambassador Training Package

Training Curriculum and Peer Education Tools

The OPTIONS Consortium, in collaboration with Collective Action, has developed an HIV Prevention Ambassador Training Package to support adolescent girls and young women (AGYW) to play a meaningful role in the rollout of oral PrEP in their communities.

The HIV Prevention Ambassador toolkit includes colorful, 1-page handouts and worksheets in a booklet format that trained HIV Prevention Ambassadors can use to conduct peer support, community discussions, and other activities. The toolkit is designed to accompany the Ambassador Training Package and can be translated into local languages.

More information is available here.

PrEP Communications Accelerator: a digital demand creation tool for sub-Saharan Africa

Online Tool and Supporting Materials

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.

Provider Training Package: Effective Delivery of Oral PrEP for Adolescent Girls and Young Women

Several Training Modules and Related Materials

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. All tools available here.

Test-And-Prevent Analysis

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Significant resources have created strong ‘test and treat’ programs globally. What about those who test negative? How can we ensure that they are given the best preventive tools to maintain their negative status? The OPTIONS Consortium envisions equally strong ‘test and prevent’ programs that link negative individuals to preventive programs in ways that work for them. In our recently completed Test-And-Prevent Analysis, FSG identified practices for linking individuals from HIV testing to HIV prevention. This work aims to identify interventions that are effective, enabling conditions that support linkage and remaining questions.

PrEP Costing Guidelines

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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

Reaching High Risk Women for PrEP: Learning from ARV-based HIV prevention trials

Study Findings

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 or read the write-up in PLOS ONE.

Country Level Analysis: Situation Analyses, Landscape Analyses, Private Sector Analyses, PrEP Rollout Analyses, and Analyses Templates

OPTIONS Integrated Service Delivery Analysis
Completed in March 2020, this analysis presents finding on the integration of oral PrEP into family planning services for AGYW in sub-Saharan Africa. This analysis builds on the product introduction framework developed by OPTIONS to support national rollout and scale-up of oral PrEP, and introduces an adapted framework to identify enabling factors for service integration. The framework was developed based on insights from seven countries: South Africa, Kenya, Zimbabwe, Malawi, Lesotho, Uganda and Zambia.
Community Dialogues: Potential users' perspectives on oral PrEP in Zimbabwe

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.
OPTIONS Plan 4 PrEP Toolkit — Helping Countries Plan for Oral PrEP Rollout

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 six steps. Implementers may use all six 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 six 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.

5. Facility Readiness Assessment

In this step, assess the readiness of healthcare facilities to deliver oral PrEP and identify areas that may require additional investment.

6. Facility Readiness Assessment

In this step, assess and compare opportunities to deliver oral PrEP through private sector healthcare channels.

If you would like guidance or instruction about how to use the Plan 4 PrEP tool, please contact us.

Oral PrEP Private Sector Landscape Analyses — Kenya, South Africa, Zimbabwe

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.

Oral PrEP Rollout Analyses — Kenya and Zimbabwe

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.

Oral PrEP Landscape Analysis for Adolescent Girls and Young Women - Kenya, South Africa, Zimbabwe

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.

Oral PrEP Situation Analyses Interim Findings — Kenya, South Africa and Zimbabwe

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

Introducing Oral PrEP in Zimbabwe: findings from community dialogues with potential users

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.

Oral PrEP Implementation Pack from South Africa (Policy, Site Selection, Communications, M&E, Etc.)
This Implementation Pack provides a comprehensive overview of South Africa’s roll-out of oral PrEP, from policy creation and site selection, to communications materials and M&E reporting processes. All materials used in the launch of oral PrEP to sex workers are included in this Pack. South Africa is the first country on the African continent to implement oral PrEP outside of studies and demonstration projects. This Pack is intended to provide insight into the National Department of Health’s (NDoH) roll-out process. The Implementation Pack was created by the NDoH and its supporting partners responsible for South Africa’s oral PrEP roll-out. PrEP Implementation Pack: South Africa 2016-2017
South Africa PrEP Information, Education, Communication (IEC) Materials for MSM, Sex Workers, and University Women

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.

Oral PrEP in Kenya: Abstract Book, Framework for Implementation, Communications Landscape Analysis

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.

PrEP4Youth

The OPTIONS Consortium, in collaboration with the National Department of Health, created five short, powerful videos that encourage PrEP as an acceptable HIV prevention method for adolescent girls and young women. Watch them here.

Literature Reviews and Summaries for Oral PrEP

Adherence Metrics in the Oral PrEP Clinical Trials: Literature Review & Trends and Takeaways
OPTIONS reviewed all oral PrEP studies that assess adherence with the aim of addressing the following question: Which adherence metrics are the most reliable for measuring adherence, and how do we know they are reliable? The literature review includes collation of studies by adherence metric, as well as efficacy and PK data for different modes of transmission.
Oral PrEP and Microbicides Literature Review and Gap Analysis: Impact, Cost, Cost-Effectiveness, Drug Resistance
OPTIONS developed a literature review of studies, reviews and analyses focused on the impact, cost, cost-effectiveness, drug resistance and other parameters of both oral PrEP and microbicides. The aim of the review was to identify the scope of the completed oral PrEP and microbicide modeling as part of an assessment to identify current modeling needs. Findings from the literature review were then used to create a gap analysis that will inform future modeling work.

Dapivirine Ring Resources

Common Agenda for the Dapivirine Vaginal Ring

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 Dapivirine Ring Introduction Matrix

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.

Dapivirine Ring Early Introduction Considerations — Seven Country Analysis

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.

Dapivirine Ring Literature Reviews: Modeling and Social/Behavioral Factors Influencing Ring Use
OPTIONS developed a literature review of studies, reviews and analyses focused on social and behavioral factors influencing dapivirine ring use. The aim of the review was to identify the scope of the completed and ongoing projects to help inform future work OPTIONS and other partners will undertake with the ring. Additionally, the team completed a literature review of modeling work that has been completed for the dapivirine ring. The aim of the review was to gain an understanding of what has already been completed to feed into modeling work that OPTIONS is currently undertaking.
Dapivirine Ring: The Case for Action
This report was written by FSG (a member of the OPTIONS Consortium) for national governments, donors, implementers and advocates who are planning for the launch of the monthly dapivirine ring. The monthly dapivirine ring is the first discrete, long-acting, HIV-prevention product designed specifically for women. It is a flexible, silicone vaginal ring that provides sustained release of the antiretroviral (ARV) drug dapivirine over one month to reduce the risk of HIV-1 acquisition. The ring is safe and reduces HIV risk. The ring is now being provided in two open-label extension (OLE) studies, HOPE and DREAM, in four countries (South Africa, Malawi, Zimbabwe and Uganda) to previous Phase III trial participants. Regulatory submissions are under way to license the product for use in countries where women face the highest rates of HIV infection in the world. First approvals in Africa could come as soon as early 2019.
Dapivirine Ring Compendium of End-User Insights

Download a summary of existing end-user research findings related to the ring and gaps remaining, all in a digestible compendium.

Oral PrEP Provider Knowledge, Attitude and Practice Resources

OPTIONS Knowledge, Attitude and Practice (KAP) Survey of PrEP Providers
The OPTIONS team conducted a review of studies, both completed and ongoing, that include knowledge, attitude and practice (KAP) surveys in sub-Saharan Africa. These surveys gather information from providers and potential providers of oral pre-exposure prophylaxis (PrEP) who work with adolescent girls and young women (AGYW). The review shows a need for further PrEP provider KAP surveys, and outlines specific gaps to be addressed by future research.
OPTIONS General KAP Quantitative Survey Template
Quantitative survey (template) to collect knowledge, attitudes and practiced behaviors around oral PrEP from health care providers.

Materials from GEMS (an MPii Project)

Policy Briefs

ART Considerations for Individuals with Recent PrEP Use
This brief provides an overview of key findings from modeling the impact of drug resistance with PrEP, conducted by the Global Evaluation of Microbicide Sensitivity (GEMS) project. It is intended to support policymakers as they develop the most appropriate first-line ART treatment recommendations during PrEP rollout. Read more.

HIV Testing Strategies in PrEP Clients
The GEMS project created this factsheet to serve as tool for policy makers and PrEP project implementers to identify HIV testing strategies specific to their PrEP program; including the use of more sensitive HIV testing methods to identify acute HIV infection. Read more.

Tools for Drug Resistance Monitoring in PrEP Programs from GEMS
The following toolkit materials are designed to assist ministries of health, project implementers and policy makers develop drug resistance monitoring programs within PrEP projects and national programs. For more on the GEMS project, click here.

POWER Formative Work Report & Other Resources

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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

Technical Briefs

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.
*Note: this resource was not created by OPTIONS but will support OPTIONS work.

Posters and Presentations from MPii Projects

IAS 2019
Conference on Retroviruses and Opportunistic Infections (CROI) 2018

MPii Microbicide Stakeholder Updates

MPii e-blast

For more information and updates on the work being done under the MPii agreements, subscribe to the MPii e-blast.


Last updated on July 10, 2020.