Beryne Odeny

Discussion on use of medical drones to support service delivery; comparison of HIV self-test distribution models - community, facility, one-stop-shop, and pharmacy; eligibility for patient enrolment in DSD models; and simplified dispensing of PrEP and HIV self-testing to support retention in HIV prevention programs.

Rosalind PARKES-RATANSHI, discusses a pilot project of medical drones to support DSD in hard-to-reach, mobile populations in Uganda. Community stakeholders were engaged to explore acceptability, benefits, and challenges. So far, there are 5 routes serving 17 peer groups, and 99 PLHIV have received at least one drone delivery. Medical drone use is feasible. Abiola ADEPOJU, compares efficiency of different HIVST models in Nigeria (STAR III). Demand for HIVST was higher among women. Community model was most effective for reaching young men (>20 years old). 99% individuals with positive tests were initiated on ART. HIVST distribution in acceptable and feasible. Sydney ROSEN, explores how soon patients should be eligible for DSD models. In Zambia, medical records were reviewed and retention was compared in “early enrollers” in DSD (<6 months on ART) and “established enrollers” (>6 months). Early enrollers had similar or better retention outcomes at 12 months. DSD enrolment algorithms need reconsideration. Katrina ORTBLAD, in a non-inferiority randomized implementation trial, investigates the effect of six-month PrEP dispensing supported with interim HIV self-testing on PrEP continuation in Kenya. At 6 and 12 months, intervention was non-inferior compared to SOC, and was superior in single women. Six-monthly dispensing simplified delivery without compromising outcomes.

Technologies in HIV prevention and treatment are rapidly evolving. There is urgent need to modify and adapt interventions for applicability to different contexts. The discussion topics embody the spirit of implementation science by shedding light on strategies that can be used to streamline intervention delivery and uptake in hard-to-reach populations like key populations, young men, and single women. Most of these presentations were based on pilot data or small trials – there is need for larger studies that evaluate the robustness of these interventions at scale. Further extension to service areas beyond HIV like STI and COVID testing is recommended.