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Prepping for PrEP: a readiness assessment among health facilities in Blantyre, Malawi

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BACKGROUND: Malawi continues to experience a high number of new HIV infections, particularly among adolescent girls and young women (AGYW), female sex workers and men who have sex with men (MSM). PrEP was first endorsed by the Malawi Government in 2019 and but was only offered specialized drop-in centers serving key populations. Integrating PrEP into health facilities requires integration of screening in service entry points where those eligible receive services. To prepare for PrEP scale-up in Blantyre, which has Malawi's highest HIV seroprevalence rate, a readiness assessment was conducted, led by the District Health Office (DHO), among 17 health centers and hospitals in December 2020, during which time only 3 people were documented to have been prescribed PrEP.
METHODS: A formal assessment was designed to measure organizational and provider readiness to begin PrEP services, conducted by a team from DHO and MaiKhanda Trust through interview of 3 key individuals at each facility. Questions focused on training of staff cadres, ability to stock and dispense medications, documentation systems, conduct of routine sexual history taking and availability of mental health services, among others.
RESULTS: Of 17 facilities, only 12 had staff who had been trained on the PrEP guidelines and were prepared to package and dispense PrEP medications. Two facilities reported staff were not prepared to routinely conduct sexual histories. Mental health services were available in 7 sites, and youth-friendly services in 13. PrEP registers had not yet been distributed but were to be located in one room in the clinic. Rapid HIV testing was available at all sites.
CONCLUSIONS: Preparing facilities to integrate PrEP in multiple service entry points is critical for scale-up and requires planning for service integration. Training of staff to assess eligibility, offer, package and dispense PrEP is necessary, including all staff who have contact with potential candidates in multiple service areas. Available co-located mental health services to address depression and anxiety, and youth-friendly services to attract at-risk AGYW and young MSM will prepare facilities to address common co-morbidities and reach youth. Registers need to be available at multiple service entry points and include fields for assessment to determine PrEP eligibility.