The Global HIV Prevention Coalition Roadmap recommends Pre-Exposure Prophylaxis (PrEP) as one of the five key HIV prevention pillars and a prevention option for people at substantial risk for HIV infection. Providing access to PrEP is one of the five strategies to meet global targets to reduce the number of new HIV infections to under 370,000 by 2025. The critical challenges in planning the PrEP implementation included setting evidence-based, epidemiologically meaningful service delivery targets at national and sub-national levels, estimating costs for implementing PrEP, and product forecasting.

Like many countries at the forefront of oral pre-exposure prophylaxis (PrEP) delivery, Kenya has encountered several programmatic challenges, such as difficulty setting targets and estimating program costs. PrEP-it, a web-based tool (version 2.0), came in handy to sort out these challenges.

The Kenyan delegation had representation drawn from NASCOP, CDC, USAID, and UNAIDS. Other countries represented include Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Tanzania, Uganda, South Sudan, Zambia, and Zimbabwe.

The PrEP Implementation planning, monitoring, and evaluation Tool (PrEP-it) were first developed as a Microsoft-Excel-based tool in 2019 in response to requests from PEPFAR teams and Ministry of Health representatives to assist with target-setting, costing, and other planning and analysis activities for oral PrEP.

The US Agency for International Development (USAID) funded the initial development of PrEP-it through the following projects: Optimizing Prevention Technology Introduction on Schedule (OPTIONS) Consortium, Health Policy Plus (HP+), and the Efficiency and Accountability Technical Assistance to Partners II (EATAP-II). Since then, PrEP-it has been used for target-setting, costing, and commodity forecasting in at least nine countries, as well as several global analyses.

Aims of the training

• Capacitate participants to use PrEP-it for target-setting, costing, and commodity forecasting for all forms of PrEP (oral, ring, injectable, etc.)
• Create a team of PrEP-it experts in each country who could cascade their knowledge in using this tool to support target setting this year and beyond
• Ensure a thorough understanding of the underlying concepts
• Help participants start planning which data sources to use.
• Mentor participants to set the first draft of national targets for their respective countries.
• Assist participants in mapping out a stakeholder-engaged process for national PrEP target-setting or other uses of the tool according to their country-specific needs

In 2021, under the USAID-sponsored Preparing for Ring Opportunities through Market Introduction Support and Knowledge Exchange (PROMISE) Collaboration and Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) Consortium, a user-friendly, web-based version of PrEP-it (“PrEP-it 2.0”) was developed.

PrEP-it 2.0 was enhanced with new features such as the ability to use all PrEP-it functions with multiple PrEP methods simultaneously (e.g., oral, vaginal ring, injectable) and the ability to aggregate targets and other tool outputs across subnational geographic units. In addition, prEP-it 2.0 (freely available at PrEPitWeb.org) was launched in collaboration with UNAIDS as part of a Global HIV Prevention Coalition PrEP webinar series in October 2021.

Kenya had already used the PrEP-it tool for target setting. Janet Mugambi, LVCT Health’s Monitoring and Evaluation Officer, and Nelius Ruiru, the Program Officer, were among the first to get first-hand tool training. The workshop helped build on the recent PrEP-it exercise that allowed them to share their experience using the tool with the other delegations. The two are among the key facilitators provided with in-depth training on using PrEP-it for national target-setting and other related analyses. In his closing remarks, Bwalya Simunyola, Chief Pharmacist in Charge of Logistics at the Ministry of Health, Zambia, said, “This is a robust tool, which is a great help to the program in Zambia.”

Regarding  future engagements and outcomes of the workshop, Nelius and Janet are expected to provide technical assistance to use PrEP-it 2.0 both in the country and in other countries, whereas the Zimbabwe team is planning a subnational PrEP target-setting/planning exercise similar to what we did in Kenya, with the training of officers at the county level.

They said they would appreciate it if LVCT Health could allow them to travel to Zimbabwe to assist with these regional training in the next financial year.

Story and photos By Nelius Ruiru, Program Officer-MOSAIC