Unitaid PrEP Project

Unitaid PrEP Project

HIV prevention, adolescent girls, young women, PrEP, SRH, HIV Prevention, South Africa,

Full Title of Study/ Programme

Integrating PrEP into Comprehensive Services for Adolescent Girls and Young Women

Rationale

AGYW in South Africa (aged between 15 and 24 years) have the highest HIV incidence, with young women in their early 20s having a four-fold burden compared to their male peers: approximately 1,745 new HIV infections occur in this cohort every week, and one third of teenage girls become pregnant before the age of 20.

To address the need of PrEP for specific focus on AGYW, the NDoH, in coordination with the DBE and DSD, are implementing the She Conquers national campaign, specifically targeting AGYW) and are aiming to:

  • Reduce new HIV infections among adolescent girls and young women
  • Reduce the incidence of teenage pregnancies
  • Increase retention of girl learners in school until matric
  • Reduce sexual and gender based violence experienced by adolescent girls and young women
  • Increase economic opportunities for young people

The project will leverage off She Conquers and focus on effective coordination and collaboration across the different channels (households/community structures, schools, technical and vocational education
training (TVETs), public health facilities, and outreach services) informed by mapping of partners and services in the selected sub-districts. To facilitate large scale PrEP access by AGYW, a range of demand creation campaigns and messaging for different target audiences (AGYW in schools, rural versus urban settings, in tertiary education, in employment and unemployed) will be designed, implemented, and monitored.

Primary Objectives

  • Increase accessibility of PrEP for eligible adolescent population in the project implementation areas
  • Identify and develop effective delivery model and appropriate use of PrEP among adolescents is demonstrated
  • Provide evidence on the use of PrEP in adolescents is generated and disseminated

Primary Endpoint/ Outcome

The primary goal of the project is to contribute to a decrease in the incidence of HIV among AGYW (age 15-24) for whom PrEP is recommended in South Africa.

Secondary Endpoint/Outcome

This project will also help to fill a gap in the global evidence base on the appropriate and most effective models for PrEP delivery, in the context of comprehensive health services (SRHR, combination prevention) to AGYW.

Study Design

Conduct formative assessments to define effective adolescent and youth engagement strategies, communication approaches, and adherence strategies

This will involve the design and conducting of formative research to understand the specific needs and preferences of AGYW with a view to identify best practices in identifying optimal geographical settings, preferred communication approaches, the design and distribution of IEC and marketing materials, and approaches to adherence support.

Monitor program performance

- The District Health Information System (DHIS) currently contains few indicators specific to adolescents, particularly providing age disaggregated service utilisation data, and PrEP indicators are not included on the National Indicator Data Set (NIDS). Wits RHI will participate in National M&E consultative forums to share lessons learned in monitoring and reporting of PrEP provision in a real-world setting to inform
the development of PrEP specific indicators and the inclusion on the National Indicator Data Set. In addition to advocating for changes in the national health information management systems, site level monitoring will be done through use of web-based integrated data collection and management system.

Implement innovative approaches for adherence monitoring and tracking

The project aims to use innovative and modern techniques to support adherence in PrEP users, including capacitating youth to use technology, exposure to new technology, and benefits for effectively using technology. Mobile support, such as a PrEP app will be used to push adherence support messages, elicit ongoing feedback, provide pill-taking reminders, and provide PrEP initiation support messages (managing side effects, healthy living, and combination prevention). Using technology in this manner will allow real-time monitoring and follow-up of PrEP users. In addition, the project will use biometric unique identifying systems to track AGYW service delivery.

Conduct operational research to generate knowledge on the use of PrEP by eligible adolescents
Conducting operational research at defined time points will aid in generating evidence, which will be used to improve program implementation, identify and document best practices and areas for improvement,
and support implementers and policy makers with information on implementation sustainability and points for future scale up. Operational research will be combined with enhanced M&E data collected at sites through electronic registers and other data sources such as mobile technology and specific quantitative and qualitative data collection.

The project will gather data, in real-world settings (PHCs, university clinics, outreach services), on priority questions. Protocols will be developed to conduct this operations research in collaboration with NDOH and with inputs from the Steering Committee.

Study Population

Collaborate with learners, schools, communities (including parents), and health care clinics across 7 sites in South Africa

Conduct costing studies of different service delivery models (PHC, campus clinics, outreach) - In terms of economic evaluations of this project, performing a cost-effectiveness (CE) approach has been opted for, measuring effectiveness through the number of HIV cases averted (incidence measure) within AGYW throughout the life cycle of this project.

Study/ Programme Site

eThekwini – Umlazi V Clinic

King Dalindyebo – Ngangelizwe CHC

Nelson Mandela – N. Brighton Clinic

Bloemfontein – Thusong Clinic

Johannesburg – Nokuphila Clinic and

Tshwane - Soshanguve Block TT Clinic

Nkomazi – Naas CSC

Study/ Programme Duration

2018 - 2020

Investigators

Dr. Saiqa Mullick, Vusile Butler

Sponsor/ Donors

Unitaid

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