HIV Prevention at Drug Shops: Awareness and Attitudes Among Shop Dispensers and Young Women About Oral Pre-Exposure Prophylaxis and The Dapivirine Ring in Shinyanga, Tanzania

Abstract

Background: HIV risk remains high among adolescent girls and young women (AGYW, ages 15-24) in Tanzania. Many AGYW experience stigma and provider bias at health facilities, deterring their use of HIV prevention services. Privately-owned drug shops, ubiquitous in many communities, may be an effective and accessible channel to deliver HIV prevention products to AGYW, including oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring. Methods: In July-August 2019, we enrolled 26 drug shops in Shinyanga, Tanzania in an ongoing study to create “girl-friendly” drug shops where AGYW can access HIV self-testing and contraception. At baseline, all shop dispensers were given basic information about oral PrEP and the dapivirine ring and were asked about their interest in stocking each. During the next 3-5 months, we surveyed AGYW (n=56) customers about their interest in oral PrEP and the ring. Results: Among dispensers, the median age was 42 years and 77% were female. Overall, 42% of dispensers had heard of a medication for HIV prevention. Almost all dispensers reported some interest in stocking oral PrEP (92%) and the dapivirine ring (96%). Most (85%) reported they would provide oral PrEP to AGYW who requested it. Among AGYW customers, the median age was 17 years; 18% of AGYW were married and 7% had children. Only 20% of AGYW had heard of a medication to prevent HIV, yet 64% and 43% expressed some interest in using oral PrEP and the dapivirine ring, respectively, after receiving information about the products. PrEP interest was higher among AGYW who were partnered and had children.Conclusions: Despite low prior awareness of PrEP among shop dispensers and AGYW, we found high levels of interest in oral PrEP and the dapivirine ring in both groups. Community-based drug shops represent a promising strategy to make HIV prevention more accessible to AGYW.

The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub‐Saharan Africa: a scoping review

“…For example, several studies indicated that clients who routinely accessed private pharmacies for sexual and reproductive health services, such as emergency contraception and sexual performance-enhancing drugs, frequently reported behaviours associated with the risk of HIV acquisition (e.g. multiple sexual partners) [43,45,58,59,66,70]. In the pilot study of the nurse-led PrEP delivery model in Kenya, HIV risk behaviours, such as engaging in transactional sex or sex with a partner of unknown HIV status, were significantly more prevalent among AGYW accessing sexual and reproductive health services at private pharmacies than at public family planning clinics [59].…”

“…In the studies that measured acceptability outcomes, our review suggests that while pharmacy-delivered HIV services are perceived to be largely acceptable, this may be conditional on pharmacy providers' ability to maintain clients' privacy [46,57,63,65,66] and provide high-quality services [53,55,63,67]. As such, implementers should consider interventions that might increase the privacy of pharmacy-delivered HIV services, such as integrating self-screening tools for HIV risk [74,75], delivering antiretroviral drugs in discrete packaging [76,77] and counselling clients in a private setting [62].…”

Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review

“…Primary healthcare services, sexual and reproductive health services, and services for mother and children are important opportunities for discussing HIV risk and offering combined prevention, not only in sub-Saharan Africa, but also in other countries, for any women who may be at risk [22]. In our search, we identified 4 articles [23–26] focused solely on women, and another 3 articles included females with males [15,16,27]. HPTN 076 [23] was a Phase II study to evaluate if rilpivirine (RPV) LA was safe as a PrEP strategy.…”

“…Exit interviews in pharmacies in Tanzania showed that 79% of married women have interest in using PrEP, with 43% willing to use a vaginal ring [26]. In South Africa, among youths, almost all the individuals, irrespective of gender, would prefer lasting (>6 m), injections or implants in the arm, but women would prefer injections over implants, and a health clinic (over a pharmacy) as a site for injection [15].…”

PEP for HIV prevention: are we missing opportunities to reduce new infections?

“…Provision of the full 28-day course of PEP at a single clinical visit, with ongoing remote adherence counselling, can reduce transport and cost barriers to the client [13,14]. PEP availability needs to be expanded to locations outside the clinics, such as through communitybased retail drug shops [15]. Community outreach needs to empower clients to increase consumer demand and PEP delivery systems that meet their needs.…”