Background: Since 2015 oral Pre-Exposure Prophylaxis (PrEP) is recommended for people at substantial HIV risk. Due to its slow roll-out, however, access remains insufficient globally, especially within national HIV prevention programs. Ongoing demonstration projects are helping document and resolve difficulties. Among them, ImPrEP is currently enrolling eligible MSM and transgender women (TW) aged 18 or older in Brazil, Mexico and Peru, while collecting clinical, behavioral, laboratory-, and systems-related data. We conducted an interim analysis of ImPrEP implementation at 9 public facilities in 6 Peruvian cities, aimed at: (1) characterizing/resolving current problems; (2) identifying potential issues in the event the Ministry of Health (MoH) decides to continue/expand this program after mid-2020.
Methods: We conducted 8 semi-structured interviews with health providers in three cities (Lima/Callao, Pisco, Pucallpa), to identify key concerns in program implementation. We also analyzed the monitoring data of PrEP implementation at all sites, to describe: gaps in infrastructure; time of implementation; and emerging issues affecting enrollment and quality of care.
Results: While the MoH co-sponsored the study, each facility was free to participate or not. The program generated interest among both providers and potential users (including MSM/TW new to the public clinics, e.g. students, people of higher income/education). Providers expressed concerns about work overload, post-study PrEP availability and drug resistance. For implementation, basic infrastructure gaps in each site were addressed (e.g. lab equipment, furniture, space renovation); this took from 3 to 9 months across sites due to varying fluidity of administrative procedures. Once enrollment began, new bottlenecks became visible: limited hours for blood sample collection (most sites); limited or unpredictable availability of physicians (5 sites), and long waiting times (most sites). Morning clinic hours, highly inconvenient for transwomen and sex workers, are common. Frequent lab supply shortages did not affect the study but may affect future PrEP roll-out.
Conclusions: Providers and users of public facilities are interested in PrEP. However, well-planned and sustainable PrEP roll-out in these facilities implies some kind of upgrade in their general conditions, hence offering the opportunity to ideally invest in strengthening the health infrastructure to offer appropriate combination HIV prevention services in Peru and similar countries.

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