MOPED599

Title

First year of implementation of PrEP in Zambia: Service delivery roll-out and scale-up

Presenter

Cassidy W. Claassen

Authors

C.W. Claassen¹, D. Mumba², M. Njelesani³, D. Nyimbili⁴, L. Mwango⁵, E. Mubanga², L. Mulenga⁶, T. Chisenga⁶, L. Chitembo⁷, H. O'Bra⁸

Institutions

¹University of Maryland School of Medicine, Center for International Health, Education, and Biosecurity (CIHEB), Lusaka, Zambia, ²National HIV/AIDS/STI/TB Council, Lusaka, Zambia, ³John Snow Inc. USAID Discover Health, Lusaka, Zambia, ⁴Procurement & Supply Management International, Lusaka, Zambia, ⁵Maryland Global Initiatives Corporation, Lusaka, Zambia, ⁶Ministry of Health, Lusaka, Zambia, ⁷World Health Organization, Lusaka, Zambia, ⁸U.S. Agency for International Development (USAID), Lusaka, Zambia

Background: Zambia adopted HIV pre-exposure prophylaxis (PrEP) as an additional HIV prevention strategy in the 2016 HIV Guidelines and expanded indications for PrEP in 2018. The Ministry of Health, National HIV/AIDS/STI/TB Council, and implementing partners (IPs), with support from PEPFAR, have since significantly scaled up PrEP services. We report data on the first year of national PrEP implementation.
Methods: We analyzed PrEP service delivery data including age/sex, key population type, and geographic reach as reported by IPs in the PEPFAR database. We conducted geo-mapping to overlay provision of PrEP services with population density and HIV prevalence.
Results: In 2017, PrEP was only available at two sites in two of Zambia''s ten provinces. In 2018, PrEP was offered in 162 sites across nine of ten provinces; 3,601 clients at risk of HIV infection were initiated on PrEP, including 1,271 (35%) adolescent girls and young women ages 15-24; 312 (9%) female sex workers, and 92 (3%) men who have sex with men. IPs reported high levels of interest and rapid uptake by clients, but poor retention in prevention services (27% are retained at 3 months). Service delivery mapping demonstrated provision of PrEP in areas of highest population density which correlated to areas of greatest HIV prevalence, with the exception of Western Province, where HIV prevalence is high but population density and PrEP service delivery is low.
Conclusions: PrEP is being rapidly rolled out across Zambia to populations most at risk of HIV infection, in line with supporting national policy initiatives. Most PrEP services are offered in urban and population-dense areas with high HIV prevalence, but rural areas with high rates of HIV are currently underserved. Further work is needed to ensure that PrEP is available to all populations at significant risk of HIV. Demand creation and awareness should complement PrEP service delivery roll-out to increase uptake.

[Figure 1. Geographic Distribution of PrEP Sites in Zambia in 2018]

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