Upscaling hiv preexposure prophylaxis implementation during covid-19 pandemic

Background: HIV Pre-Exposure Prophylaxis (PrEP) was introduced in South Africa in October 2019.Low levels of PrEP uptake and retention were observed through to May 2020. The Coronavirus Disease 2019 (COVID-19) pandemic and nationwide lockdown in March 2020 contributed to additional challenges in PrEP upscale in the following ways: • Reduction in HIV Testing Services (HTS) due to facility headcount reduction and suspension of community HTS • Healthcare facility closures and/or reduction in staff after confirmed COVID-19 cases. • Suspension of in-person trainings on PrEP scheduled for March-May before all clinicians were trained • Reduction in onsite mentorship Methods: After a decrease during lockdown in April, we conducted first round of virtual trainings in May Over June-August 2020, we implemented a PrEP acceleration plan that included the following strategies: • Provision of performance targets with online coaching and mentoring for clinical staff • Virtual guidelines training of 300 clinical staff • Printing and distributing IEC materials and job aids • Integration of PrEP into HTS including HIV Self-Screening and Index testing • Stringent monitoring of PrEP drug stock and performance • NDoH-endorsed multi-month dispensing of PrEP drugs Results: During lockdown, PrEP initiations decreased by 40% between March and April and following the first round of virtual trainings, increased by 182% between May and June 2020.The growth plateaued in July, before implementation of the PrEP acceleration plan which catalysed a significant growth spurt both in August of 110% (1,413/764) and in September 102% (2,753/1,413) with these two months alone accounting for 67.4% (1,857/ 2,753) of the total clients initiated since the inception of the programme. Conclusion: A multi-pronged approach to manage the challenges caused by the COVID-19 pandemic succeeded in improving PrEP initiation and retention. We recommend sustained medicine availability, virtual trainings and mentorship sessions combined with PrEP/HTS integration be implemented to improve upscaling of PrEP services during a pandemic and nationwide lockdown.