The Joint United Nations Programme on HIV/Aids (UNAids) had aimed to have 3 million active pre-exposure prophylaxis (PrEP) users by the end of 2020, but with only 575 000 enrolled by June,  the target will not be met. This has intensified calls for differentiated PrEP delivery models. 

A learning curve  

Speaking at the virtual 23rd International Aids Conference on Monday on Bringing PrEP closer to home, Rachel Baggaley from the World Health Organisation (WHO) says countries must learn from the Covid-19 pandemic and implement strategies to deliver PrEP in simpler ways by using various platforms.   

“Differentiated PrEP is the way to go. We must learn from the Covid-19 pandemic on how to deliver PrEP in a simpler way as we must make it accessible to all. We also need to nurture and support young PrEP users,” says Baggaley. 

According to WHO, PrEP is the use of an antiretroviral medication to prevent the acquisition of HIV infection by uninfected persons and it may either be taken orally, using an antiretroviral drug available for treatment of HIV infection or topically as a vaginal gel containing tenofovir. 

UNAids’ latest report on the global Aids epidemic shows that 2020 targets will not be met because of unequal success and Covid-19 risks impacting HIV progress. According to the report, “690 000 people have died of Aids-related illnesses last year and 12.6 million of the 38 million people living with HIV were not accessing the life-saving treatment“. 

Innovation is key 

Despite at least 78 countries offering PrEP, lack of diversity in terms of service delivery models have been viewed as a challenge. Robyn Eakle from United States Agency for International Development (USAid) says countries must innovate and come up with new ways to deliver PrEP. 

“We must use lessons from Covid-19 to change our ways. We must innovate and decentralise pick-up points and move away from facilities. More virtual platforms such as social media need to be used and ATM drugs can be another model which can be used,” says Eakle. 

In South Africa, according to the Aids Map website, “PrEP was first introduced into sites for female sex workers (FSWs) in June 2016, then into sites for MSM [men who have sex with men] in April 2017, into university sites for young students in October 2017, and most recently in May 2018 into general sites for young people.“ 

How it has already been done  

Saiqa Mullick, the director of implementation research at the Wits Reproductive Health Institute, says that with the Covid-19 pandemic, they had to decentralise service delivery to decongest facilities because they were unable to hold face–to–face consultation but needed intensified engagement and  information. 

“All our online communication [is] geared towards driving clients to either project PrEP supported facilities or reaching out to a ascertain a need for medication drop-off or collection,” she says. 

“We developed role specific job aids to assist integrated PrEP, ART [antiretroviral therapy] and Covid-19 messaging and social mobilisation to help decentralise services delivery. Intensified telephonic [calls] followed the decentralised approaches proved successful in bringing clients and keeping them coming back,” she adds.   

The 23rd International Aids Conference, known as Aids 2020, ends on 10 July. – Health-e News.