Integrated community delivery model to improve PrEP uptake and continuation for AGYW in Mazowe district, Zimbabwe


BACKGROUND: The Ministry of Health and Child Care (MOHCC) has been offering Oral Pre-exposure prophylaxis (PrEP) as part of combination HIV Prevention in Zimbabwe since 2017. PrEP is effective in reducing risk of HIV acquisition in high prevalence settings. Access to services including PrEP is a challenge for hard-to-reach rural communities, compounded by COVID-19 restrictions. Pangaea Zimbabwe AIDS Trust (PZAT), in collaboration with MOHCC and Zimbabwe Technical Assistance, Training and Education Center (Zim-TTECH) embarked on integrated clinical outreach services to ensure PrEP uptake, effective use and continuation among vulnerable Adolescents Girls and Young Women (AGYW).
DESCRIPTION: From January to August 2021, integrated clinical outreach services were conducted around Mvurwi Hospital catchment area, Mazowe District to deliver a comprehensive package of services including oral PrEP, HIV testing and treatment, family planning, gender-based violence prevention and immunisation to community doorsteps. Outreach points were identified based on remoteness. MOHCC and implementing partners collaboratively map points and plan the outreach visits. A PrEP Champion who is an AGYW mobilises clients and raises awareness on PrEP ahead of the outreach. A multidisciplinary team including nurses and counsellors delivers services during the outreach. Outreach services are conducted monthly offering consistent and uninterrupted services. Data was captured and reported using standard MOHCC tools.
LESSONS LEARNED: Integrated delivery of services at community level improves access and utilization of services including PrEP. Between January and August 2021, 344/366 (94%) AGYW tested for HIV were negative, 157 were assessed for risk and 144 (92%) were initiated on PrEP. At outreach points, 296 AGYW collected PrEP refills.

CONCLUSIONS: Partners' collaboration in communities through integrated planning and implementation is essential for successful delivery of HIV prevention services including PrEP. Comprehensive HIV service provision can be effectively implemented with support from peer mobilisers. Under COVID-19 restrictions, communities can still access health services including PrEP using this delivery model.

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