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Introducing a comprehensive approach to implementing, scaling up, and strengthening HIV pre-exposure prophylaxis (PrEP) service delivery in Ukraine

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BACKGROUND: The WHO recommends the use of antiretroviral drugs by HIV-negative individuals to reduce HIV acquisition. In 2018, Ukraine adopted this recommendation by launching PrEP on a limited scale, with a primary focus of reaching men who have sex with men (MSM). Ukraine's national goal is to cover 10% of key populations, or >60,000 people, with PrEP services, including people who inject drugs, MSM, sex workers, and partners of people living with HIV. In 2019, only 1,735 individuals received PrEP in Ukraine.
DESCRIPTION: To scale up and strengthen PrEP delivery in Ukraine, the International Training and Education Center for Health (I-TECH) initiated a technical assistance program for PrEP. The program aimed to establish PrEP provision as a standard of care in 39 public-sector healthcare facilities (HCFs). Baseline needs assessment showed a lack of standardization in PrEP provision and demand for comprehensive PrEP training among healthcare workers (HCWs). I-TECH developed guidelines for daily and event-driven PrEP delivery and conducted two training sessions for HCWs. PrEP clients in the program received free creatinine and HBV testing. I-TECH also supported PrEP information campaign.
LESSONS LEARNED: From October 2020 to September 2021, 39 HCFs engaged in program, including 19 clinics new to PrEP delivery. During the program year, 1,540 clients received PrEP at least once, this exceeded anticipated annual client target (n=891). Two-thirds were males in their thirties, 39% (n=451) of ART-naïve clients who started PrEP were referred from the I-TECH-supported HIV assisted partner testing program implemented at participating clinics. Coverage of key populations increased significantly (Figure 1).

CONCLUSIONS: The first-year program results demonstrated increasing demand for PrEP among clients of public-sector HCFs. The program also identified positive synergies of HIV partner testing and PrEP in engaging new PrEP clients. In 2021-2022, I-TECH is expanding its technical assistance to 89 HCFs to increase access and ultimately client enrollment.