In the quest to bring groundbreaking HIV prevention products to the forefront, the CATALYST (Catalyzing Access to New Prevention Products to Stop HIV) study emerges as a beacon of innovation. Spanning Kenya, Zimbabwe, Uganda, Lesotho, and South Africa, this dynamic study is actively shaping the future of HIV prevention methods for women and girls in Africa, a population disproportionately affected by the HIV virus;
CATALYST takes a bold step in assessing Pre-Exposure Prophylaxis (PrEP) options and decoding the intricate factors that influence individuals’ choices. Conducted across six sites in Nairobi, Mombasa, and Kisumu counties in Kenya, This study is a trailblazer in empowering individuals with the knowledge to make informed decisions about their HIV prevention options.
Under the MOSAIC project funded by PEPFAR through USAID (2021-2026), CATALYST assumes a pivotal role in maximizing options for informed HIV prevention choices. With a grand vision, the study aims to enlist approximately 1,100 participants in Kenya for a transformative two-year journey and help generate new evidence on product perspectives and preferences for enhanced HIV prevention coverage and reduce new HIV infections.
In the world of CATALYST, informed choice is not just a phrase; it’s a mantra. Emphasizing autonomy, knowledge, and freedom from coercion, participants are encouraged more than ever to choose the HIV prevention method that resonates best with them within the specific market context.
PrEP: Decoding Preferences and Usage Patterns
Pre-Exposure Prophylaxis (PrEP), a revolutionary method using life-saving antiretroviral therap by HIV-negative individuals to prevent HIV acquisition, takes center stage in the CATALYST study. This initiative is dedicated to understanding the nuances of PrEP choices, usage patterns, and the dynamic evolution of preferences among participants.
The first-of-its-kind study provides full information on and access to three biomedical HIV prevention methods – daily oral pre-exposure prophylaxis (PrEP), the dapivirine ring (a monthly vaginal ring also called the PrEP ring), and the newly Kenya Pharmacy and Poisons Board-approved injectable cabotegravir for PrEP (CAB PrEP) that is administered every two months.
In Kenya, the implementation of CATALYST is a collaborative effort involving key stakeholders such as the Ministry of Health, LVCT Health, PATH Kenya, University of Nairobi, and the Bar Hostess Empowerment and Support Program (BHESP).
LVCT Health is a key PEPFAR implementing partner in Kenya contributing to 20% of the country’s population on life saving antiretroviral therapy (ART) and over 10 million individual supported with HIV prevention, testing, treatment, sexual reproductive health and gender based violence services over the years. With this study, LVCT Healthand her consortium partners will advance HIV prevention science for adolescent girls and young women, getting us closer to the goal of ending HIV as a public health threat by 2030.
The study is being conducted at the “Mukuru Health Centre” and at a “BHESP clinic” in Nairobi County. BHESP, a women-sex-worker-led organization, is a formidable force influencing policy, fostering an enabling environment for quality HIV services, and championing human rights awareness and economic empowerment for sex workers, gender minority women, and adolescent girls and young women (AGYW).
Participation in the CATALYST study is a voyage of choice. With complete autonomy, participants can withdraw or switch methods at any time without affecting the routine services provided by healthcare providers. Privacy and confidentiality are non-negotiable pillars of the study.
The study employs a comprehensive informed consent process, allowing women to discuss various PrEP options with healthcare providers and make choices based on their unique needs and lifestyles. Follow-up visits, occurring one month after enrollment and every two to three months, offer participants a continuum of care.
Challenges the CATALYST Study Faces
As with any groundbreaking initiative, CATALYST faces challenges such as the prevalence of myths and misconceptions among community members, particularly women. These misconceptions range from the belief that the PrEP ring might migrate into the uterus after insertion to the misunderstanding that only the PrEP ring is available within the study.
Moreover, some participants expect compensation, making it essential for research assistants to communicate to them that there is no direct compensation for study participation during routine clinic visits calling for tact and clarity to ensure that participants grasp the study’s true purpose: to provide them with comprehensive information for voluntary involvement.
Another noteworthy challenge is the discomfort some potential participants experience with the notion of assisted ring insertion by a healthcare provider. Overcoming this discomfort is crucial to grant participants access to the study’s benefits. Research Assistants are working diligently to convey the option for self-insertion with health care provider guidance, an empowering approach that allows participants to take control of their health.
Despite these challenges, CATALYST is addressing participants’ concerns, providing clarity on using the PrEP ring with contraceptives, its effectiveness, managing potential side effects, and dispelling myths related to its use.
Lessons Learned and Collaborative Success
Support from peer leaders and educators, collaboration with facility staff, and the formation of a community advisory board (CAB) are instrumental in the success of CATALYST. The CAB serves as a vital mechanism for ongoing community stakeholder engagement, providing independent input into the study and amplifying its impact.
In the realm of CATALYST, each participant is not just part of a study; they are pioneers in shaping the future of HIV prevention. As this study continues to unfold, it promises not only to bring new HIV prevention products closer to the market but also to inspire a new era of informed choices for the AGYW. By offering three distinct prevention options and tracking participant feedback, PEPFAR delivery sites in Kenya, Lesotho, South Africa, Uganda and Zimbabwe and the world at large can can better anticipate the demand for new methods and then offer methods that are more likely to meet the specific needs and preferences of women and girls.
Authors: Naumy Mumo, Nelius Ruiru, Harriet Tzindoli, Dorah Bloch, Jane Muturi
Reviewers: Festus Mutua, Freshiah Njoroge