Empowering Providers: PrEP Choice Counselling Session
This content discusses strategies for empowering providers to offer PrEP choice counselling to adolescents and young people, focusing on informed decision-making and exploring different modalities of PrEP delivery. Through workshops and script development, key stakeholders collaborate to enhance the effectiveness of PrEP counselling and adoption. The aim is to improve PrEP persistence and overall acceptance by evaluating and addressing potential barriers and enablers to implementation.
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Presentation Transcript
Elzette Rousseau, Desmond Tutu Health Foundation Welcome to the era of PrEP choice PrEPared to Choose: Choice counselling to empower providers and youth 22 26 July Munich, Germany and virtual aids2024.org
Simplified PrEP delivery within an informed choice approach WHO PrEP choice counselling should be done by the counsellor. PrEP information may be given by other PrEP providers (nursing staff, peer navigators, etc), but the counselling approach is conducted by the counsellor. WHEN PrEP choice counselling is initiated after HIV testing (see Step 1)
PrEPared to Choose overview An evaluation of CAB-LA delivery, in a new context of PrEP choice, amongst adolescents and young people in South Africa To compare persistence on PrEP by modality (injectable vs oral vs vaginal ring) and PrEP overall (any modality) over the short term (6 months) and long term (18 months). To determine the best combination of implementation strategies to achieve optimal PrEP adoption (decision to use PrEP), initiation (first PrEP dose), and persistence. Using RE-AIM. To describe safety, tolerability, and acceptance of all three modalities (and so inform reasons for PrEP non-persistence) Exploratory, secondary aim will describe and compare HIV incidence across the three modalities (*sample size insufficient for a formal analysis). 1 AGYW 1100 2 PBFW 100 MSP 300 3 MSM 300 4
Development of the PrEP choice script A co-created counselling script with key stakeholders (youth, PrEP providers, peer navigators) Consolidation of findings from these formative workshops + NODH CAB LA guidelines + Literature on established counselling techniques 2 x formative workshops with the 2 groups (PrEP providers, youth, and family planning choice providers) = work on the four workshop objectives. December 2023 January 2024
Development of the PrEP choice script Objective 1: Present the incoming PrEP products and compare and contrast the perceived advantages and disadvantages of each product from the perspective of the PrEP provider and PrEP user. 1 Objective 2: Characterise what is required (e.g. specific information, counselling, confidentiality, time, etc.) to promote informed decision making amongst adolescent participants when choosing a PrEP product. 2 Objective 3: Co-create a PrEP choice counselling script for PrEP providers to use during the PrEPared to Choose project in public facilities. 3 Objective 4: Identify potential enablers and barriers to the implementation of the PrEP choice counselling process at the level of the community, the healthcare facility, the PrEP provider, and the PrEP user. 4
Client awareness and counselling journey
Client informed decision- making
Self- reflection & quiz - Participant administered Add up the scores Ask them if this score correlates with how they feel about the choice - - At this stage, what is their preferred product?
Readiness for adoption assessment Using their identified product, ask the following: Y-axis: rate your interest in using the product out of 0-10 with 0 being not interested at all and 10 being very interested X-axis: rate your confidence in your ability to use the product (i.e. take a daily pill, self- insert the ring, return for injections ) out of 0-10 with 0 being not confident at all and 10 being very confident Plot the answer on the chart and determine whether they are: READY Ready BUT Not Ready
Early findings Product choice: 74% choose CAB-LA CAB-LA roll-out feasible at public facilities Mobile Truck 766 (70.7%) Vuyani Clinic 318 (29.3%) Total Oral PrEP 268 (24.7%) 23(19-28) 71(58-85) DVR CAB-LA Total N (%) PrEP Products at baseline Oral PrEP DVR CAB-LA 1084 (100.0%) N (%) Age m(IQR) Weight (kg) Population MSP AGYW PBFW* 13 (1.2%) 24(20- 26) 89(70- 95) 803 (74.1%) 24(20-28) 72(60- 85) 1084 (100.0%) 24 (20-28) 71 (60-86) 219 (28.6%) 13 (1.7%) 534 (69.7%) 49 (17.2%) 0 (0.0%) 269 (82.8%) 268 (24.7%) 13 (1.2%) 803 (74.1%) 111 (41.4%) 154 (57.5%) 5 0 19 24 0 (0.0%) 13 (100.0%) 239 (29.8%) 550 (68.5%) 350 (32.3%) 717 (66.1%) MSM PrEP experienced No Yes 3 (1.1%) 0 (0.0%) 14 (1.7%) 17 (1.6%) PrEP persistence at M1 222 (82.8%) 46 (17.2%) 6 (46.2%) 7 (53.8%) 527 (65.6%) 276 (34.4%) 755 (69.6%) 329 (30.4%) Oral PrEP (attended/due) 35/118 (30%) DVR CAB-LA* (attended/due) 369/430 (86%) (attended/due) 0/9 (0%) *369/587=63% (within 7-day window) 22 26 July Munich, Germany and virtual aids2024.org
Early findings: choice counseling Demographics and product choice Interest and confidence in chosen product 933 participants were enrolled between 13 February 21 June 2024 70.3% (656/933) were PrEP experienced 703/933 (75.3%) chose injectable PrEP, of which two went on to receive oral PrEP and one a vaginal ring, on clinical grounds 23.7% chose oral PrEP and 1% (n=10) dapi-vaginal ring 88.7% (828/933) participants rated their interest in their chosen product >8/10 91.5% (854/933) felt confident (>8/10) in their ability to take the product The majority (639/933, 68.5%) selected their PrEP product based on compatibility with lifestyle 12.9% chose product based on perceived safety, 7.6% based on preferred route of delivery, and 6% based on preferred side-effect profile 22 26 July Munich, Germany and virtual aids2024.org
Early findings: reasons for switching from original PrEP choice Switch from oral to longer acting method (ring or CAB-LA) due to side effects, need for discretion, pill-taking burden Switch to oral or vaginal ring for de- medicalised, simplified PrEP delivery (courier delivery) lifestyle fit 22 26 July Munich, Germany and virtual aids2024.org
Thank you FastPrEP strategic and operational management team: Linda-Gail Bekker, Dvora Joseph Davey, Carey Pike, Ntombovuyo Mathola, Mbali Jonas, Philip Smith, Thando Wonxie, Ntando Yola, Onesimo Vanto, Melissa Wallace, Pamela Fuzile, Chelsea Coakley, Pippa Macdonald, Bryan Leonard, Keitumetse Lebelo, Carey Pike Social Scientists: Lauren Fynn, Siyaxolisa Sindelo, Prisca Vundhla, Fiona Bennin, Mbali Mngqibisa FastPrEP mobile teams: Pakama Mapuka, Ande Kholisa, Ncumisa Nothobela,Ayanda Qinga, Andiswa Gatyeni, Xolisa Mondliwa, Vuyisa Dumile, Nkosiyabo Futshane, Mfundo Hababisa, Lwazi Thami, Yoliswa Faku, Yolanda Mpande, Cheslyn Louw, Busisiwe Lento, Buntu Norman, Lusindiso Baliso, Lunga Notenga, Siphelele Jako Noma Hokolo, Thamsanqa Mrwebi, Kwanda Xaso, Thozama Langa FastPrEP peer navigators: Noluthando Magudu, Ntombizanele Gqesha, Siphesihle Siyeka, Siphosethu Bota, Yamkela Mangwane, Zintle Ngesi, Kholelwa Mjayezi, Buyiswa Ntwanambi, Levania Titus, Masonwabe Mbhejwa, , Sip[hosetu Gqomfa, Abongile Mdingazwe, Asive Mzola, Simfumene Magidigidi, Zine Kose, Bongiwe Siqholo, Esona Maxhama, Mandisi Phika, Onele Nomji, Zimasa Msongelwa, Anazo Somgqeza, Anele Maseti, Erin Herbert, Lukhanyo Mzimane, Sive Mphambaniso, Zikhona Buhe, Vuyiseka Yiba, Thina Somdaka, Pakama Mbizweni, Phaphama Sifingo, Esethu Javu, Ayanda Xamane FastPrEP Youth Reference Group, youth CAB, CAB, WCDoH stakeholders, facility managers 22 26 July Munich, Germany and virtual aids2024.org
