Welcome to the last differentiated service delivery (DSD) newsletter of 2022 from IAS – the International AIDS Society. In this edition, we focus on DSD for PrEP with insights from Zimbabwe and Zambia. Long-acting injectable PrEP will support DSD for HIV prevention in Zimbabwe Joseph Murungu, Senior Technical Advisor, Pangaea Zimbabwe AIDS Trust, Zimbabwe, writes:
Over the past decade, Zimbabwe has made great strides towards reducing new HIV infections among the general population – a 70% reduction between 2010 and 2021, according to UNAIDS estimates. Despite this significant progress, the number of new HIV infections per year is still unacceptably high as the country missed the 2020 target of a 90% reduction in new infections. It is now important to ensure that HIV prevention programmes reach previously underserved groups who may benefit the most from combination HIV prevention interventions, including pre-exposure prophylaxis (PrEP). In its latest PrEP implementation guidance brief, the World Health Organization (WHO) recommends differentiated, simplified, de-medicalized and comprehensive PrEP services. DSD, as outlined in this country policy development brief, simplifies PrEP by providing easier-to-collect, longer PrEP refills at more convenient locations. It reduces the clinical package at certain types of visits, enabling lay cadres to manage such visits and increasing utilization of virtual platforms, and supports service integration. The brief also recommends that people using PrEP should be assessed for suitability and have the option to choose a less intensive differentiated PrEP service delivery model as soon as it is feasible. Large-scale access to different PrEP options, including CAB-LA, however, will only be possible if the price of CAB-LA is substantially reduced. In addition, we need to address issues around availability, health system preparedness, human resources, client/people-centred service delivery platforms, supply chains and monitoring effective use, as well as creating a stigma-free, friendly environment. We have exciting new HIV prevention methods available – now let’s make them affordable and accessible to ensure that people can access the PrEP option that works best for them.
DSD in action: Improving key populations’ access to HIV testing and prevention services in Zambia “In Zambia, the social network testing strategy has been an effective way to influence uptake of health services among hard-to-reach key populations.” We spoke with Linah Kampilimba Mwango, Technical Director at Ciheb Zambia and Deputy Chief of Party for the Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) project, and Henry M Sakala, Key Population Technical Lead on the CIRKUITS project.
What are some of the challenges faced by key populations and HIV testing and prevention in Zambia? Sex work and same-sex sexual relations are criminalized in Zambia. Punitive laws and law enforcement practices make it more difficult for HIV programmes to reach sex workers, men who have sex with men and transgender people. Hostile environments and stigma, even from healthcare providers, limit key populations’ access to HIV services due to fear of arrest, detention and discrimination. There is an inadequate offering of key population-friendly services in the country and only a limited number of healthcare providers are trained in key population sensitivity, safety and security. How does social network testing address the challenges faced by key populations in accessing HIV testing and prevention services in Zambia? The social network strategy is based on the theory that people in the same social and sexual networks have similar risk behaviours. It involves identifying “recruiters”, who include: (1) people living with HIV; and (2) people vulnerable to acquiring HIV. Recruiters must also be willing to recruit “network members”, or members of their social or sexual networks, for HIV testing and prevention services. Once network members are recruited and receive an HIV test, they are given the opportunity to become recruiters for their own networks. The process of enrolling key populations to test and recruit their social and/or sexual network members continues, producing successive waves of recruitment that can extend into hidden networks and to hard-to-reach clients. Recruitment and testing of network members are encouraged and sustained through small monetary or non-monetary incentives. |
