PREP Innovations (need a title)

The COVID-19 pandemic has created new challenges and opportunities for providing life-saving HIV prevention services to those who are most at risk for acquiring the virus. Meeting this challenge, CDC is implementing a new community level intervention that delivers three months of HIV prevention medication directly to clients, decreasing the risks associated with clinic visits during the COVID-19 pandemic.

These innovative delivery programs in Kenya and Tanzania utilize peer counselors who drive rickshaws to deliver pre-exposure prophylaxis (PrEP)  , a medication which when taken daily can prevent HIV infection, is proving successful.

In Tanzania, the program, which delivered 2,000 refills last year, is funded by President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC and is managed by Columbia University’s International Center for AIDS CARE and Treatment Programs (ICAP), a CDC community implementing partner in Tanzania.  Due to its success in distributing medication, CDC plans to maintain the program after the COVID-19 pandemic has ended and expand it to the entire country.

The Tanzania PrEP program is just one of many efforts to decrease barriers to HIV prevention services during the pandemic.  Other interventions include using web resources to provide virtual self-assessments, case tracking and access to virtual support groups.

A blessing in disguise

Kenya is also dispensing three-month refills to clients in a

Virtual groups that take place on platforms like WhatsApp, have replaced safe spaces that served as a meeting place for people to share emotional support and  There, peer counselors can connect with clients to ensure people are continuing to take their medication while maintaining social distancing guidelines.

“I think COVID came as a blessing in disguise because we have been able, through virtual technology to increase capacity building for providers. As opposed to physical trainings where we could only reach a few providers, we can now reach 500 in a single session,” said   Patricia Oluoch,

Medically preventing HIV

Access to PrEP is integral to comprehensive prevention services. PrEP is a daily pill that provides one of the most effective methods for preventing HIV among people who are at highest risk of contracting the virus. When taken regularly, before being exposed to HIV, PrEP prevents HIV infection by stopping the virus from replicating in the body. Consistently using PrEP reduces the risk of acquiring HIV by about 99 percent.

Keziah a Determined Resilient, Empowered, AIDS-free, Mentored and Safe girls (DREAMS) peer counselor in Kenya, takes PrEP. She and her husband have a young son, but like many men her husband has to travel far away to earn a living.

“I started taking PrEP soon after my son was born because my husband works far from home and I did not want to worry about contracting HIV,” she said.

In 2020, PEPFAR, intensified focus on PrEP, prioritizing access for all people like Keziah within a country who face substantial risk of acquiring HIV. Previously, key populations (KPs) and (adolescent girls and young women AGYW)  were targeted for PrEP because they experience higher levels of risk compared to the general population. Now, the requirement mandates that anyone in a country who faces an increased risk of HIV infection should have access to the medication.

CDC experts warn that countries must sustain HIV prevention efforts during the COVID 19 pandemic or risk reversing major achievements in the global fight against the epidemic. Pandemic lockdowns have contributed to increased sexual violence, exacerbated issues with supply chains–limiting availability of food, and decimated economies leading to job loss. All factors that can contribute to increased risk of acquiring HIV.  Due to many of these factors, there has also been an uptick in sex work, a key risk factor in contracting HIV. 

In addition, the current youth bulge in sub-Sharan Africa also threatens to dramatically increase the number of adolescents who will acquire HIV. Unless resources are swiftly mobilized to manage this population trend, all the gains made in sub-Sahara could be eliminated in one generation.

Zuhura works with girls and women who are at risk of for acquiring HIV as a DREAMS peer counselor in Kenya. “Because of the pandemic there are no jobs and some women have resorted to sex work” she said.

HIV prevention has slowed the spread of HIV and saved lives in countries that have been hardest hit by the epidemic, but COVID-19 coupled with the possible increase in viral loads due to the youth bulge could reverse global progress.

CDCs peer led programs

These new programs are part of CDC’s broader efforts to increase access to PrEP and HIV prevention, globally, to those at greatest risk for acquiring the virus. As a key implementer of PEPFAR, CDC has provided PrEP to nearly half (46 percent) of all people who take the medication in PEPFAR supported countries since 2017, and is supporting the Determined Resilient, Empowered, AIDS-free, Mentored and Safe girls (DREAMS) program.

Peer led models for HIV prevention amidst COVID-19 have proven successful CDC plans to continue their expansion to save lives and remain on course to achieve epidemic control.

“Eliminating HIV begins with prevention,” said Patricia. We have to give people proven strategies like PrEP to reduce new infections.”