Funders, health providers and advocates should take lessons from the rollout of voluntary medical male circumcision (VMMC) as an HIV prevention measure in Africa if they wish to hasten access to programmes providing pre-exposure prophylaxis (PrEP), researchers argue in the International Journal of STD and AIDS.
Their article adds to similar papers on the lessons that PrEP implementers can learn from the history of contraception.
Jason Reed of Jhpiego, Rupa Patel of Washington University in St Louis and Rachel Baggaley of the World Health Organization start by saying that VMMC and PrEP are very different HIV prevention measures. The first is a one-off medical intervention whose effects last for life, but whose efficacy is in the region of 60-70%. The other is a medication that needs to be taken daily or regularly, but which achieves almost 100% efficacy with good adherence. But, they add, there are many lessons from the implementation of VMMC programmes that can also apply to PrEP, particularly in the areas of sustainability, demand creation and community engagement.
As reported recently by aidsmap.com from the International AIDS Conference, PrEP is slowly gaining a foothold in lower-income countries, though still largely as a series of demonstration projects. South Africa and Kenya both have national PrEP strategies they are beginning to implement, with smaller programmes underway in Zimbabwe, eSwatini (Swaziland) and Senegal. In Asia, Thailand and Vietnam have programmes for men who have sex with men and trans women, as well as pilot programmes for sex workers in India.
But we are a long way from the three million people UNAIDS has adopted as its target for PrEP access by 2020. Read more via AIDSmap
Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up
Reed JB, Patel RR, Baggaley R. Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up. International Journal of STD and AIDS, early online publication. doi: 10.1177/0956462418787896. August 2018.
Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact:
Establish safety surveillance systems
Engage communities and encourage government ownership
Innovate demand creation activities
Create service delivery models
Coordinate complex supply chains
Utilize mathematical models to forecast impact and identify best-placed investments
Plan for sustainable programmes
Anticipate technological advances
Leverage programmes as gateways to other services
Coordinate global advocacy