PrEP Learning Network: Addressing Challenges and Achieving Success Integrating PrEP into Other Health Services - Speaker view
Welcome everyone and please feel free to write questions or comments here in the chat!
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Question from Mohammed Ibrahim: How did the integration increase women empowerment? Was there any GE messaging integrated in the integration process?
Question from Ha Pham: How can you define adherence? Revisit on schedule or continuation?
From @HaPham: How can you define adherence? revisit on schedule or continuation?
Question from Mohammed Ibrahim: Do you have any experience implementing this integration in adolescent friendly corners (area dedicated to adolescent clients only)?
@HaPham: Family planning programs do not monitor for adherence, but they may monitor for continuation (returning for refills or follow-up dosing). We have a resource sheet on PrEP continuation from the Sept 12th webinar on the PrEPWatch Learning Network site: https://www.prepwatch.org/virtual-learning-network/
What are the factors should we need to assess to integrate PrEP into FP or other services?
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Given the need for structured followup for those on oral prep in the context of FP point of care, do we know the magnitude of effort or additional work load on FP service providers and how might we use task sharing to manage the work load?
In Malawi we are just starting to scale PrEP services, but the new guidelines recommend integration with ANC, FP and STI services. The beneficiaries are KPs, high risk AGYW and discordant couples, so some community entry points as well
From Christine Obinju: The major challenge in PrEP provision is adherence. We need to focus on how to address adherence and issues surrounding adherence.
The USAID contacts are: Jennifer Mason (email@example.com), Robyn Eakle (firstname.lastname@example.org) and Nithya Mani (email@example.com)
In addition to adherence, we need to review retention issues that look at patients who disengage in care without notifing the clinician versus those who are discontinued on treatment by a clinician. Also, how do we accurately mention retention in cases when patients feel that they are no longer at risk
Question from Mohammed Ibrahim: Does your intervention include any health facility that is not providing HIV counseling and testing?
Question from Jane Otai: Can we conclude that integration is possible when both HIV and FP are well resourced?
In Zimbabwe, can you share some insights into the inclusion of STI/STD sceeening/management?
Question from Nkosinathi Miziya: Can we elaborative on long term contraceptive methods (Implant / IUCD) integration of PrEP seems not feasible.
From Christine Obinju: We could also engage the male partners of AGYW on PrEP with this community sensitization needs to be strengthened
In the Zimbabwe pilot study, can you explain a bit more on the indicators that were used to monitor and assess integration ?
How did you develop your risk assessment questions?
Question from participant: How was the picture of retention for both services in a long run (by June)?
Dr Mwanza Wa Mwanza
With Poor male involvement in MCH, how do we address the issue of GBV?
can we look at integration of PrEP/FP and STI testing
Question from Mohammed Ibrahim: Do you have a separate integrated training material or use government training materials for PrEP & FP?
From Mohammed Ibrahim: Male engagement should be a part of MNCH/SRHR programming to have greater impact
From the Zimbabwe study Which M&E tools were integrated is it all from screening to reporting?
From Mohammed Ibrahim: availability of commodities is the most important part of integration, if the pilot project provided commodities, what will be the sustainability of the intervention?
you mentioned only four factors that challenges to integrate PrEP to FP, Do you have any problems related to commitment from high level and staff motivation?
One of the real and perceived advantages of LARCs eg. implants or IUDs, is the notion that it is so effective one can get and forget about it until its time to replace or remove--I wonder how oral prep and LARCs use will affect user's decisions?
Patrick, can you share your thoughts on how long does it take to complete the risk assessment tool and combined with counseling the overall time needed ?
Question from participant: What was the picture of retention during the period and will it require formulation of an integrated training resources for delivering FP&PrEP training?
@More: great example of Test-And-Prevent in Lesotho!
From More Mungati: Very interesting conversation. In Lesotho we have integrated PrEP into index testing services being fully aware that the target population is the same. HIV negative clients are then assessed for eligibility for PrEP while positive sexual partners are linked to ART and indexed.
From Michael Odo: What implication or do risk do we expect with the average retention not exceeding 3-4 months?
@Michael: we are all still grappling with how to understand continuation and cycling with PrEP, as long as a client covers their at-risk periods, then they should be protected. So we need to think more in terms of "effective use" (covering periods of risk) vs. "continuous use". There are some reflections on this in the PrEPWatch LN link shared previously and there is much discussion across countries, partners and donors as to how we should measure success with PrEP continuation given that it is so different from treatment (that requires daily meds for life).
Botswana is implementing PrEP and FP for AGYW. Initially a buy in from MoHw was key and it was key to have MoHw protocols and procedures to guide implementation of PrEP. It is feasibe to intergrate PrEP in already exisiting health services. For APC 2.0 PrEP demand creation was integrated in post GBV care service delivery, Index testing, STI screening and management and community mobilization for prevention of harmful gender norms.
Question from Jane Otai: We mainly talk of integrating PrEP into FP and not the other way around. Should we not also have FP integrated into PrEP services?
@ Jane: Great point! Yes!
Question from Christine Obinju to Josephine: How did you align the visits of FP and PrEP visits being that mostly we give long term FP methods while PrEP requires a visit at month 1 and then month 3. Assume a client visits today and is on Implanon, how do you tackle retention?
APC 2.0 have experienced low retention of AGYW on PrEP,and different reasons given for discontinution or refusing PrEP.So in order to strengthen adherention and retention on PrEP we did community initiation and reinitiation of AGYW to PrEP. We hpe to expand our services to community refill points where AGYW can easily access PrEP witthout necessarily coming to the facility.
Comment from Ha Pham: In Vietnam, we integrate PrEP into STI/STD settings
Dr Mwanza Wa Mwanza
I would like you to share more light on the patient/client side. the integration could work well from the provider side if all structural barriers are addressed. mostly on Adherence and Retention including stigma.
Comment from participant: Referring girls to PrEP room is good though I think having these services in the same room would be a great idea for sustainability.
Question from Michael Odo: How were the @risk population determined within the FP setting knowing PrEP value is best at population incidence of 0.3?
In Cambodia, we want to integrate PrEP into FHC too? Can you share us an experience, Nina?
A combination approach is working well in AGYW integrating PrEP,STI treatment and FP in community setting on a scheduled basis
How does the training of HCW address the attitudes that tend to deter AGYW from going to facilities? In many contexts, these attitudes are linked to cultural norms and are not easy to change, especially over the course of a training?
From Maria Sanena: integrating services especially in MoH facilities in existing services such as FP has been challenging as most often it is viewed as just adding burden to an already over stretched workforce in the facility. Often times this is left to the extra staff from the IPs of the program and intervention. What has been the reception of the service providers from the MOH in service delivery? How do you motive them to ensure they are focused on this?
Question from Bridget Jjuuko: How was PrEP retention measured within the study (POWER)?
Question from Michael Odo: How was dose adherence determined in this work, and was there fidelity in required periodic testing?
Does integrating Prep and FP reduce the stigma compared to accessing Prep in ART clinics?
From Christine to Josephine: Can you also try a differentiated model where all these services are done in a community set up then you compare the uptake of PrEP with that of facility integration? Probably the DREAMS model
From Bridget Jjuuko: Was POWER able to capture key reasons for dropping off PrEP?
Do you think the KP will go to the FP for PrEP?
Thanks Bonilla for those insightful presentation. Can you explain further about who does the followup for those who drop off oral prep and needs additional management of side effects, reintroduction etc..? Are they the FP providers ?
The two phase community screening followed by mobile community nurse visit sounds like a great idea since we have peer educators among AGYW and KPs
From Ha Pham: If we integrate PrEP into FP, how about MSM?
Just some feedback from my experience in implementing PrEP in KZN, South Africa. We had implemented PrEP through two models i.e. health facility model and a community-outreach model. We offered a range of HIV and SRH services in both models i.e. HIV testing services, screening for GBV, STIs and TB, ART initiation for HIV positive clients and PrEP initiation for HIV negative clients. We also offered sexual behavioural risk screening, family planning and distribution of condoms. We noted that there was higher uptake of services by AGYW within the health facility model as comapred to the outreach model. PrEP uptake within the community model was higher amongst older males. Also, stigma was higher in with community model as compared to the health facility model
personally, we should integrate PrEP into the service where most clients use it and also based on the prevalence those group like KP where frequently use the STI clinic.
@Vannak: Good point!
Thank you so much.
Good bye and thank you for your hosting