How can access to PEP and PrEP be improved in rural African areas?

Francisca Boenders, Managing Director, Sexuelle Gesundheit Zürich SeGZ

The studies are designed differently, for different key populations and with different drugs, but all aim to identify and explore new ways of accessing PEP/PreP.

Patricia Ong'wen on the uptake of HIV post-exposure prophylaxis (PEP) in private retail pharmacies in Kenya: initial results of the Pharm PrEP study

The initial situation: In this study, 45 specially trained private pharmacies in central and western Kenya offer subsidised PEP and PrEP treatments to customers. These are pharmacies where the key populations regularly buy contraceptives, condoms, etc. There is often already a relationship of trust between the pharmacy and the customer.

Conclusions: Initial data from this study indicate that PEP is in high demand in private pharmacies in Kenya and could be offered in partnership with public support. Furthermore, the results suggest that integrating PEP and/or PrEP into HIV prevention programmes could contribute to better care for people with different HIV prevention needs.

Elijah Kakande on knowledge, awareness, feasibility and acceptability of long-acting cabotegravir for HIV prevention: results from the SEARCH Dynamic Choice HIV Prevention Study

The baseline: Injectable cabotegravir (CAB-LA) is a highly effective drug for HIV prevention, but studies on its practical use in men and women in Africa are lacking. The ongoing SEARCH Dynamic Choice HIV Prevention (DCP) randomised trial in rural Uganda and Kenya assessed the evidence, awareness, feasibility and acceptability of CAB-LA for prevention.

Conclusions: In rural Uganda and Kenya, more than half of study participants who had a choice between oral PrEP/PEP and CAB-LA chose CAB-LA and started it in the first 48 weeks. CAB-LA was popular with both men and women and was completed with high satisfaction.

Euphemia L. Sibanda on preferences for pre-exposure prophylaxis services among sexually active adolescent girls and young women: a discrete choice experiment in Zimbabwe

Baseline: Adolescent girls and young women in Zimbabwe are disproportionately affected by HIV. As PrEP is being rolled out in Zimbabwe, preferences for PrEP services among sexually active adolescent girls and young women (SA-AGYW) in Zimbabwe were analysed and key drivers of demand for PrEP services were identified.

Conclusion: PrEP programmes can be optimised to reach sexually active AGYW if PrEP is offered by friendly CHWs or local public clinics, at low cost to users, in locations that are within walking distance, with short waiting times and the option of injectable PrEP. Programmes should be accompanied by activities to promote parental support for HIV/STI.
 

Stephanie Roche Pharmacy-based provision of long-acting injectable PrEP in Kenya

Baseline: Four countries in sub-Saharan Africa have approved long-acting injectable PrEP for HIV prevention. As countries decide where to make injectable PrEP available to maximise impact, private pharmacies are one of the options being considered. 
To understand the potential barriers and facilitators to providing injectable PrEP through private pharmacies in Kenya, qualitative formative research was conducted with 16 private pharmacies, their clients and key stakeholders.

Conclusion: Injectable PrEP stakeholders are interested in pharmacy-based provision. Further implementation research is needed to identify and test specific strategies for capacity building and integration.

Conclusion:

All of these studies have shown that it is possible to reach key populations in this setting and that there is acceptance to take up these prevention services.
There are the same challenges as in Switzerland when implementing innovative prevention measures to ensure that the services (PEP, PrEP) reach the key groups. 
It has been shown that in these African countries, low-threshold access to PEP/PrEP is possible via trained pharmacies. The advantages:

• High acceptance among service providers and the key population
• It has been shown that short distances to the provider are necessary, reachable on foot in a short time
• No waiting times
• the pharmacy offers a safe space

However, there are still a number of hurdles to overcome before PEP and PrEP reach the key groups across the board in this way:

• Legal hurdles need to be overcome and guidelines developed so that these prevention measures can be offered in private pharmacies.
• Funding must be clarified so that the key groups can afford the programmes.
• Pharmacies need to be trained so that good prevention settings can take place and ART is also possible.
• There must be a safe space in the pharmacy, i.e. an extra room, so that these settings can take place.