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Engaging PrEP Champions to improve uptake and continuation on PrEP among AGYW in the DREAMS Program in Matabeleland North Province, Zimbabwe

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BACKGROUND: Oral pre-exposure prophylaxis (PrEP) implemented as part of combination prevention reduces the risk of HIV infection by 99%. The level of protection provided by PrEP depends on adherence. Pangaea Zimbabwe AIDS Trust (PZAT) supports the delivery of PrEP as part of the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) program aiming to reduce new HIV infections among adolescent girls and young women (AGYW) aged 15-24 years. PrEP interventions for AGYW include monitoring PrEP uptake, continuation, and psychosocial support.
DESCRIPTION: Starting January 2021, PZAT engaged 16 AGYW (mean age 23 years) as PrEP Champions (PCs) in Matabeleland North province and trained them on effective engagement of AGYW using a standard Ambassador Toolkit developed by the Optimizing Prevention Technology Introduction on Schedule project to provide peer-to-peer support, mobilization, education, and linkage to PrEP. PCs supported effective use and continuation on PrEP through telephone calls, text messages and in-person follow up. Community dialogues with AGYW were conducted around catchment areas of the 16 supported health facilities and PrEP support groups were formed. Feedback from AGYW was used to address gaps and improve programming. Data were captured and reported using DHIS2 through supported facilities.
LESSONS LEARNED: The proportion of newly initiated AGYW continuing on PrEP at month 1 increased from 40% in November 2020 to a peak of 91% in July 2021. A temporary PrEP stock-out affected performance in August 2021.


CONCLUSIONS: PCs were cited in community dialogues as sources of accurate information that led to an increase in knowledge and linkage to PrEP services for AGYW. Coordination between the health care workers and PrEP Champions resulted in joint defaulter tracking. Peer-to-peer support through interpersonal and mobile platforms leads to successful awareness raising, improved uptake and continuation on PrEP. Collection of long-term continuation data in future promotes further analysis of the impact of PCs.