Initial implementation of PrEP in Zambian correctional facilities demonstrates high uptake among incarcerated people


BACKGROUND: As of 2021, Zambia has an estimated 21,078 incarcerated persons across 87 correctional facilities with occupancy of over 300%. Incarcerated persons represent a critical key population who are often at risk of HIV infection during incarceration but have limited access to HIV prevention options. The prevalence of HIV infection among incarcerated people in Zambia is estimated at 17.4%, over 50% higher than the national HIV prevalence. The University of Maryland Baltimore (UMB) has recently begun providing HIV pre-exposure prophylaxis (PrEP) to incarcerated people under the CIRKUITS and Z-CHECK projects.
DESCRIPTION: UMB started implementing PrEP service in the Zambia Correctional Services (ZCS) facilities in October 2020. Prior to scaling up PrEP services, orientation meetings were held with the ZCS leadership, where the benefits of PrEP for incarcerated people were explained. UMB trained 28 ZCS health care workers in PrEP management using the national PrEP training package. Inmates that screened positive for substantial HIV risk were offered HIV testing; those who tested negative were further counselled and offered PrEP services.
LESSONS LEARNED: From October 2020 to January 2021, across 18 correctional facilities from Eastern, Lusaka, Western, and Southern Provinces, a total of 8,065 inmates, 7,659 (95%) males and 406 (5%) females aged >15, were assessed via the PrEP and HIV Prevention Screening tool. Of these, 777 (9.6%) were initiated on PrEP, including 738 (95%) males and 39 (5%) females, respectively. The distribution of inmates reached with PrEP screening by age group and PrEP initiation by age group was similar. The highest proportion of inmates reached and initiated on PrEP was in the 25-29 years age group, 1,574 (20%) and 193 (25%), respectively.
CONCLUSIONS: We describe one of the first demonstrations of PrEP service delivery in correctional settings in sub-Saharan Africa. Initial service delivery efforts have provided PrEP to a substantial number of incarcerated people in Zambia. Further assessment is needed of uptake, persistence, and adherence, as well as justice-involved persons'' perceptions of risk and preferences for combination HIV prevention services. Offering PrEP in correctional settings is a key strategy to offer HIV prevention services for this underserved key population.