By Kerry Mangold and Ayesha Ismail, Genesis Analytics, South Africa
For far too long, PEP in African countries has been associated solely with occupational HIV exposure and survivors of sexual violence. The untapped potential of PEP in curbing new HIV acquisitions remains a critical concern, especially considering the 1.3 million new acquisitions in 2022, a figure well above the global target.
However, a promising shift is underway as national ministries of health echo calls for the “rejuvenation”, “nurturing” and “revitalization” of PEP in Kenya, South Africa and Zimbabwe, respectively.
We are at a pivotal moment, channelling this collective energy to effectively implement the World Health Organization’s (WHO’s) recently revised PEP guidelines, which recommend community delivery and task sharing, ultimately aiming to get PEP closer to the people who need it.
Innovative delivery models and a swift alignment of supportive policies will be essential to make PEP more accessible; these models include online delivery, vending machines, pharmacy access and use of mobile clinics and drop-in centres with strong linkages and referrals. Moreover, integrating PEP into the broader prevention landscape, including the services offered to key and vulnerable populations, is crucial.
As countries embark on reimagining HIV prevention strategies and capitalize on the current momentum spurred by the updated PEP guidelines, there is a pressing need to advocate for and prioritize PEP as a pivotal component of HIV prevention efforts.
Through collaborative efforts, like the South-to-South HIV Prevention Learning Network (SSLN) and its i2i (insight to implementation) stream, we are documenting valuable insights and best practices on effective delivery, showcasing the translation of global directives into community-focused solutions. This collaborative platform supports countries to swiftly document, share and adapt their programmes based on regional learnings and best practices, paving the way for a more robust HIV prevention response, placing PEP in the foreground as part of the Choice agenda.
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By Maria Cristina Abbate, STD/AIDS Coordination Office of São Paulo, Brazil
Promoting access to HIV services for populations disproportionately affected by the HIV epidemic is a global challenge that requires reaching beyond the confines of health units. To address this, the STD/AIDS Coordination Office of São Paulo has implemented initiatives that integrate HIV prevention into daily life.
The Coordination Office has provided internal and external condoms in over 90 bus terminals and stations across the city, a compact health unit within a subway station, and the “PrEP on the Street” project, which brings services to open high-traffic areas. In addition, it has installed automated dispensing machines for PrEP, PEP and HIV self-tests at two subway stations serving more than 180,000 passengers daily.
This effort has significantly expanded access to prevention via the SPrEP – PrEP and PEP Online platform, which offers teleconsultations every day (including holidays and weekends) through a free app provided by the Municipal Health Department. Through this online service, users receive their prescriptions and a QR code for access to the prophylactics at the machines.
In the first five months of operation, these machines registered over 1,000 distributions, showing a continuous increase in access for all users. Among women, for instance, there has been an increase in PEP access, indicating a demand for this preventive method and demonstrating the viability of meeting this demand by expanding the availability of prophylactics.
