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PrEP initiation in community safe spaces increases PrEP access among key and priority populations in Zambia

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BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention, yet uptake remains limited particularly among key and priority populations (KPs/PPs). In Zambia, PrEP has been available at government health facilities since 2017; however, KPs and PPs remain unreached through traditional health services. Novel ways are needed to provide PrEP access to KPs and PPs.
DESCRIPTION: Under the Z-CHECK and CIRKUITS projects, the University of Maryland Baltimore (UMB) implemented community PrEP initiation in October 2020. UMB conducted hotspot mapping to identify at-risk populations, and then set up community prevention posts (CPPs). CPPs provide a safe space within the community for KPs/PPs to access health services, including health education, HIV testing services (HTS), and PrEP. UMB recruited and trained community health workers to conduct HTS and PrEP education, and then facilitated health facility nurses to initiate PrEP on site at the CPP. KP gatekeepers helped to educate and mobilize KPs to access PrEP.
LESSONS LEARNED: From October 2020 to December 2020, UMB set up 8 CPPs for community PrEP initiation, initiating 4,533 clients in the community. Of these, 2527 (56%) were female, of whom 811 (32%) were aged 20-24 years and 615 (24%) were aged 25-29 years; 2006 (44%) were male of whom 477 (24%) were aged 25-29 years and 399 (20%) were aged 30-34 years (see Figure 1). Among 2,543 (56%) key populations initiating PrEP in the community, 1849 (73%) were female sex workers, 525 (21%) were men who have sex with men, 116 (5%) were transgendered persons, and 53 (2%) were people who inject drugs.

Figure 1. Age and Sex Distribution of Community PrEP Initiation, Oct-Dec. 2020

CONCLUSIONS: Community PrEP initiation via CPPs is an effective way to reach underserved KPs and PPs in Zambia with biomedical HIV prevention. Further assessment on PrEP continuation amongst community initiates is needed.