Community interventions to reach Adolescent Girls and Young Women (AGYW) supporting Pre-Exposure Prophylaxis (PrEP) initiation and continuation in Rwanda

BACKGROUND: While Rwanda has nearly reached the 95-95-95 goals, adolescent girls and young women (AGYW) remain disproportionately affected by HIV: prevalence among AGYW and their male counterparts is 0.5% vs 0.3% [10-14 years], 0.8% vs 0.4% [15-19] and 1.8 vs 0.6% [20-24] (2018 Rwanda PHIA). Since 2018, Rwanda has used PrEP as an HIV prevention choice for AGYW, female sex workers, men who have sex with men and discordant couples at substantial risk of HIV infection. Though PrEP is initiated at facility level, community interventions are critical for success through demand creation, education, identification and referral of at-risk AGYW, and follow up.
DESCRIPTION: ACHIEVE Rwanda, a USAID- and PEPFAR-funded project, had implemented DREAMS activities in two Kigali City districts since October 2020. Through two local partners: YWCA and DUHAMIC-ADRI, ACHIEVE serves 24,974 AGYW (10-24 years) with HIV prevention education and services; and PrEP interventions (education, demand creation, community screening, referrals to health facilities, and adherence counseling) targeting AGYW age 18+ who are sexually active and at risk of HIV infection.
From October 2020-September 2021, 5,145 HIV-negative AGYW were screened and 668 (13%) were found at risk of HIV and referred to health facilities for PrEP eligibility screening and initiation. Sixty percent (402; 23% [18-19], 72% [20-24], 5% [24-29]) were eligible and initiated PrEP. The project, through training, coaching, and mentoring, prepared 159 DREAMS mentors to deliver community PrEP services.
LESSONS LEARNED: Mentors facilitate PrEP community interventions through the safe space model for demand creation and community screening; effective linkage and coordination with health facilities; community adherence support; and routine engagement with AGYW. This strategy contributed to PrEP initiation among AGYW with a continuation rate of 94% and 91% respectively at one- and three-months' post-initiation. Mentors further support those who discontinued PrEP, empowering them to use other prevention measures and reinitiate PrEP when needed.
CONCLUSIONS: Community HIV prevention interventions capacitating and engaging mentors have shown contribution to PrEP strategy implementation through demand creation, identification, referral, adherence counseling, and community follow-up.