Nancy Padian

This session reviewed several delivery mechanisms for Prep (e.g. community, health centers and integrated into family planning clinics.

Several findings are germane to implementation research. Community support is key. Ravipa Vannakit from USAID in Thailand presented data on the critical role of key populations in all aspects of Prep Uptake including community mobilization and service delivery and even data collection. In Zimbabwe, Makaita Margaret Gombe, from Chai reported on higher uptake of Prep in rural compared to urban clinics. The hypothesis for the difference is the involvement of village chiefs who mobilized all stakeholders (heath workers, parents, educators etc.) in order to generate demand. Retention and long-term adherence are obviously key and challenging to measure outside the confines of a research study. Luana Monteiro Spíndola Marins, Fundação Oswaldo Cruz, Brazil presented encouraging data using three measures od adherence: pill count (returned bottles), self-report and MPR. All three measures were highly correlated and had good positive predictive value although rates of false negatives were relatively high.

Overall uptake results are promising, but far more work needs to be done on understanding and maintaining retention and long-term adherence

Pedro Carneiro

In this session we learned about PrEP delivery across the globe, including key population-led initiatives in Thailand, PrEP integration within family planning clinics in sub-Saharan Africa, PrEP within the Brazilian public health system, efforts to improve retention in care among Senegalese FSW and PrEP use among adolescents in the USA.

Moussa Sarr discussed FSW receiving PrEP in Senegal and their retention to care, which increased to 75% by the end of the first year – older women had better retention in this group and there were no new HIV infections reported. In Thailand, Ravipa Vannakit reported the key population-led initiatives which have largely contributed to increased uptake of PrEP amongst those who need it the most. In Brazil, Luana Marins discussed adherence of PrEP among MSM and TGW, which was measured via self-report and dried blood testing. In Kenya and Zimbabwe, Jillian Pintye and Makaita Gombe presented data on family planning clinics that had successfully delivered PrEP alongside birth control. In the USA, David Magnuson presented data that demonstrated adolescents have lower utilization of PrEP compared to older age groups. An interesting pattern showed more girls under 18 taking PrEP

Overall this session demonstrated that PrEP delivery can be successfully implemented in a variety of different contexts, at times using preexisting infrastructure. More efforts are needed to support those impacted by the social determinants of health. PrEP has the potential to be integrated into family planning clinics, sexual health clinics and even youth centers. Retention to care and adherence measures need to be better understood to tailor unique interventions to various communities.