Health system adaptations and considerations to facilitate optimal oral pre-exposure prophylaxis scale-up in sub-Saharan Africa

7 July 2022

Countries in sub-Saharan Africa have progressively scaled up oral PrEP as part of combination HIV prevention. Initial scale-up efforts have generated progress, drawing lessons from existing HIV interventions, such as antiretroviral therapy and biomedical prevention. However, beset by unprepared health systems, scale-up has been slow. This review synthesises literature on essential considerations for PrEP scale-up, highlighting the importance of health system adaptability and responsiveness.

Featured Resources

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Pre-Exposure Prophylaxis Implementation Gaps among People Vulnerable to HIV Acquisition: A cross-sectional analysis in two communities in western Kenya, 2021–2023

This article, from Journal of the International AIDS Society, examines PrEP awareness, uptake, and persistence among participants enrolling into an HIV incidence cohort in Kenya.

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Initiation and Continued Use of Oral Pre-Exposure Prophylaxis among Pregnant and Postpartum Women in South Africa (PrEP-PP): A demonstration cohort study

This article from The Lancet HIV describes the results of a demonstration study in South Africa, PrEP-PP, to integrate oral PrEP provision into public clinics offering antenatal and postnatal care to pregnant and lactating people.

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Acceptability of Six-Monthly PrEP Dispensing Supported with Interim HIV Self-Testing to Simplify PrEP Delivery in Kenya: Findings from qualitative research

This article from BMC Health Services Research discusses the results of a pilot in Kenya to explore the acceptability of dispensing PrEP twice a year, with interim HIV self-testing, versus quarterly, with clinic-based HIV testing.

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Dynamic Choice HIV Prevention with Cabotegravir Long-acting Injectable in Rural Uganda and Kenya: A randomised trial extension

This article from The Lancet HIV discusses the results of the SEARCH dynamic choice study conducted in Kenya and Uganda, comparing outcomes between one group offered a choice between oral PrEP, post-exposure prophylaxis, and cabotegravir for PrEP, and a second group receiving the standard of care.

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Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A longitudinal qualitative study from a crossover trial in South Africa, Uganda, and Zimbabwe

This article from AIDS and Behavior explores South African, Ugandan, and Zimbabwean adolescent girls and young women’s experiences in a crossover trial of two HIV prevention products: daily oral PrEP and a monthly dapivirine vaginal ring.

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Role of HIV Self-testing in Strengthening HIV Prevention Services

This article from The Lancet HIV examines the potential role of HIV self-testing (HIVST) in achieving HIV prevention goals by looking at trials of use of HIVST with prevention tools such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and voluntary medical male circumcision (VMMC).

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We Choose: Adolescent girls and young women’s choice for an HIV prevention product in a cross-over randomized clinical trial conducted in South Africa, Uganda, and Zimbabwe

This article from PLOS One describes decision-making and product choice amongst adolescent girls and young women in South Africa, Uganda, and Zimbabwe when given a choice between oral PrEP and the dapivirine vaginal ring as part of the REACH crossover study.

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“I was given PrEP, but had no privacy”: Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya

This article from PLOS One describes the results of a study using adolescent girls and young women as “mystery shoppers” in Kenya to identify barriers to effective PrEP service provision.

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Formalized Peer Referral to HIV Pre-exposure Prophylaxis Supported with Self-testing: A mixed-methods pilot study among young Kenyan women

This article from Frontiers in Public Health describes a pilot study in Kenya using peer providers and HIV self-test kits to link adolescent girls and young women to PrEP services.

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HIV Self-Testing and PrEP: Opportunities for scale-up

This brief addresses common misconceptions about the use of HIV self-testing (HIVST) for PrEP initiation and continuation while highlighting the opportunities that HIVST can provide in order to support further scale-up of this important self-care option.