A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa

Abstract

Background Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities. Methods We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16–25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context. Results A total of 585 young women started PrEP at the TTT between July 2017 – October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT’s integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery. Conclusions PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.

Oral pre‐exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study

“…Also, our volunteers were all <25 years, an age group that has continually shown lower PrEP uptake than older individuals [ 19 , 22 ] likely due to their generally low HIV risk perception [ 23 , 24 ]. In South Africa, mobile health clinics operating in locations frequented by AGYW are feasible, acceptable and improve PrEP uptake [ 25 ]. PrEP integration into sexual reproductive health services also facilitates uptake among AGYW [ 26 ].…”

Novel Platforms for Biomedical HIV Prevention Delivery to Key Populations — Community Mobile Clinics, Peer-Supported, Pharmacy-Led PrEP Delivery, and the Use of Telemedicine

“…AGYW and people who engage in transactional sex especially prefer to obtain PrEP in clinic locations where they receive contraceptives as it may reflect comfort with trusted and familiar spaces [ 23 ]. When PrEP was provided at a mobile clinic in Cape Town as part of an integrated sexual and reproductive health service, AGYW described it as a de-medicalized service that fit more conveniently into their daily lives [ 14 , 24 ]. AGYW on the POWER PrEP demonstration study in South Africa described that having sexual and reproductive health services in the community made it feel like the service was focused on them and their health needs, and with the mobile clinic entering the spaces of adolescents and young people’s naturally occurring networks, demand creation and peer-support for PrEP uptake were automatically generated [ 3 , 24 ].…”

“…When PrEP was provided at a mobile clinic in Cape Town as part of an integrated sexual and reproductive health service, AGYW described it as a de-medicalized service that fit more conveniently into their daily lives [ 14 , 24 ]. AGYW on the POWER PrEP demonstration study in South Africa described that having sexual and reproductive health services in the community made it feel like the service was focused on them and their health needs, and with the mobile clinic entering the spaces of adolescents and young people’s naturally occurring networks, demand creation and peer-support for PrEP uptake were automatically generated [ 3 , 24 ]. Uptake of PrEP for key populations is further facilitated when services at mobile clinics are provided in a culturally appropriate, client-centered, and friendly manner by community-based trusted health providers.…”

“…Mobile health clinics are mobile by nature and as they are based in the community, face broader community challenges (e.g. community riots, severe weather conditions), and together with the high mobility of adolescent and young people’s lives, coordination of PrEP refill visits were constrained at times [ 24 ].…”

“These Girls Have a Chance to be the Future Generation of HIV Negative”: Experiences of Implementing a PrEP Programme for Adolescent Girls and Young Women in South Africa

“…Specifically, evidence shows that PrEP offers powerful protection for women, and therefore AGYW have been prioritised for PrEP delivery [ 13 , 14 ]. PrEP effectiveness is dependent on access, adherence, and persistence [ 10 ]. Importantly, access, use, and adherence to PrEP also requires substantial commitment and support from health care providers [ 15 ].…”