Unique package of service for successful oral PrEP roll-out
By Alfred Itunga, Technical Communications Officer, LVCT Health
Without special attention from service providers, many oral PrEP users fall into poor adherence exposing them to HIV infection. A unique package of services that is flexible, friendly and sensitive to the needs of different populations can help with adherence.
Some demonstration project sites where LVCT Health offered oral PrEP saw drop-offs in the weeks following initial enrollment. LVCT Health developed a package of services that responded to the needs of clients and the real-life challenges faced by the young women in the program.
The project took advantage of integrated services offered at the clinics. By reaching out to clients receiving family planning, prevention of mother to child transmission and other sexual and reproductive health services, the project connected with many young women who were eligible for oral PrEP services.
Project staff also adopted a strategy known as differentiated care. This model customizes services to the needs of a particular population, so that clinic hours, access to commodities like condoms, or education on oral PrEP and sexual health addressed the particular risks they face. This helped to ensure that oral PrEP users received services that helped them take oral PrEP correctly and consistently. For example, extended clinic hours allowed women to meet with staff and pick up their prescriptions at times that did not conflict with work or family life.
In addition to offering continuous medical education to the service providers, a 24-hour hotline gave worried oral PrEP users a way to ask questions and allay concerns at any time. When a young women needed that reassurance she found the same service provider who met her at the clinic on the other end of the phone line.
“So, I would say that the service provider who they've already entrusted would be the same—ideally the same person to answer this hotline number. In case, they had any problem, they could go up and call that number, and most of the time, I had the phone, so I answered promptly.”
—Matilda Abwok, researcher at LVCT Health
Engaging women in the project in a warm and friendly way played a key role in retention. Oral PrEP users mentioned this as one of the reasons why they would come back for the services. Young women especially said their experience with service providers at the demonstration facilities was different and more welcoming than services they received at other public health facilities.
“And it happens, so someone finds it hard to go there [public health facilities]. Even when we tell them about PrEP they say we want to go to LVCT health center. Because that place is so friendly and so I would like to request the government to be a bit friendly.”
The package of services included support groups, with 10 to 20 oral PrEP users meeting frequently to share their experiences and ask those challenging questions. LVCT Health supported this weekly platform which gave project participants assurance that they were not alone, and allowed them to support each other through challenges.
“Sometimes when I stay at home I get really stressed. When I go to the support group and listen to what others are saying I find that I relax. I know that I am not alone.”
Whether it’s managing side effects, stigma or adherence, these group discussions offered personal, consistent support. Providing a protected space for peers to discuss their challenges, such as managing medication or the stigma associated with HIV.
The challenges to good oral PrEP adherence are both individual and societal, both practical and complex. Projects that intends to be successful should consider a package of services that accommodates the needs of clients, keenly ensuring that it is flexible and supports women on their journey with oral PrEP.
There’s no question that a simple regimen of a single daily pill can slash HIV infections in people at risk. But although millions of people around the world could benefit, only 200,000 are prescribed PrEP, and 75 percent of them are in the United States. The disparity was the focus of anguished discussions this week at the largest annual US HIV/AIDS conference.
The Center for AIDS Research at Emory University's Rollins School of Public Health produces interactive online maps with visualized data on different aspects of the US HIV epidemic, and its prevention and treatment response, at AIDSVu.org. This set of maps and statistics focuses on PrEP use nationally and by state from 2012-2016.
The International Treatment Preparedness Coalition (ITPC) has released the Key Population Activist Toolkit on PrEP, developed to equip community activists to demand pre-exposure prophylaxis (PrEP). The toolkit includes step by step guidance for activists to develop an advocacy agenda to bring effective PrEP programs to their communities.