The failure to provide HIV services for key populations explains why the world is not on track to reach targets to end AIDS. This is one of the findings of the World AIDS Day report 2022, released by UNAIDS in the lead up to World AIDS Day this week. The report, aptly titled Dangerous Inequalities, also shows no significant decline in new infections among gay men and other men who have sex with men in both the western and central Africa and eastern and southern Africa regions.
In response to calls for practical steps to be taken to increase availability, quality and suitability of HIV treatment, testing and prevention services, particularly for key populations, Aurum POP INN is pioneering the roll out of event-driven PrEP (ED PrEP).
First of its kind
A first of its kind in South Africa, Aurum POP INN is rolling out ED-PrEP and conducting an evaluation study to understand it’s acceptability among men who have sex with men (MSM) and transgender women (TWG). It is being conducted in five districts in three provinces, namely; Gauteng, Mpumalanga and KwaZulu-Natal.
POP INN offers free sexual health services to MSM and TGW. The clinics provide a safe space for key populations communities to collect PrEP or ART, receive counselling, screening for HIV, STIs and TB, as well as psychosocial support services, in an environment that is tailored for them to receive healthcare without stigma or discrimination.
Take control
Lungelo Zondo has been a daily PrEP client at POP INN uMgungundlovu for three years. “I decided to switch to ED-PrEP because if helps me take control of my sex life. Sometimes we forget or can’t take our pills, especially when you know you’re not going to be with someone, it almost makes taking the pill feel like it’s for no reason. But with ED-PrEP, I am in control and can actually protect myself when I anticipate something will happen,” he said.
Mpho Mankayi, a Nimart Nurse at POP INN eThekwini, explained why the regimen is also known as 2+2+1, so called due to the dosage and timing. “You take two tablets two to 24 hours before sex. Then if you do have sex, you take one more tablet 24 hours after the first dose and another one 24 hours after that, hence 2+1+1.”
Innovated
POP INN has been providing PrEP since 2018, however, according to Programme Manager Matshidiso Chabane, they found that clients were opting out due to the pill burden. “While continuing to promote and provide daily PrEP, we innovated so that we are responsive to our client's needs. We are implementing this evaluation study on ED-PrEP with the guidance of CDC.” She added that this was the same medication- Truvada- used in daily PrEP, what is different is the regimen, which is based on WHO guidelines for the event driven dose.
Providing tailor made sexual health services to #MSM and #TGW, is just one way Aurum is responding to the #WAD2022 theme- #Equalize.
— The Aurum Institute (@Auruminstitute) December 1, 2022
Watch Jermaine Pekoba talk about his experience getting on #PrEP through @inn_health eThekwini. @CDCSouthAfrica
#HIV #WorldAIDSDay pic.twitter.com/Rot4ICEfl2
Tshenolo Mojapelo from Ekurhuleni, east of Johannesburg, is participating in the study. “I take my health very seriously but even I found taking it is difficult, especially when you are not sick. When I heard about ED-PrEP, the POP INN counsellor talked me through it and I did the assessment and decided to participate,” he said.
Part of the evaluation study is a self- risk assessment questionnaire for clients to use to understand whether or not ED-PrEP is better suited for them, said Jacqueline Pienaar, Aurum Technical Director and primary investigator on the study. “We have also developed screening tools and job aids to support healthcare workers in assessing the eligibility of clients for ED-PrEP.” Also part of the study is collecting information about how MSM and eligible TWG are engaging with the regimen. “ED-PrEP is not included in PrEP guidelines in South Africa because there are concerns about people not understanding the dosage and getting it wrong, therefore risking infection. So part of the study is building out the messaging, looking at what works and what doesn’t. We’re developing tools to go with implementing ED- PrEP, covering both the clients and healthcare workers. We will then provide all of this information to government to make a case for ED-PrEP to be included in the guidelines,” added Pienaar.
Equalize
The World AIDS Day 2022 theme: Equalize, calls for inequalities holding back progress in ending AIDS, to be urgently addressed. Aurum has been responding through our work in HIV clinical and implementation research and HIV/ TB integration. We also support the national HIV programme, with our staff working in more than 300 clinics and hospitals in three districts in the North West province in South Africa. Through this PEPFAR funded programme, Aurum has tested almost 1.2 million people for HIV, with 98% of those who tested positive initiated on ART since World AIDS Day in 2021.
