TUPEC416: Challenges and Barriers to PrEP Implementation ...
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TUPEC416: Challenges and Barriers to PrEP Implementaon in Public Health Facilies in Lan America: Inial Lessons from the ImPrEP Demonstraon Project in Peru Cáceres CF 1 , Konda KA 1 , Calvo G 1 , Guanira JV 1,2 , Salazar X 1 , Nunez-Curto A 1 , Vargas S 1,3 , Lugo E 1 , Guerrez X 1 , Huaman B 4 , ImPrEP Study Group 1Universidad Peruana Cayetano Heredia, Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Lima, Peru, 2 Invesgaciones Medicas en Salud, Lima, Peru, 3 Universidad Peruana Cayetano Heredia, Sexual Health Laboratory, Lima, Peru, 4 Ministry of Health of Peru, HIV, STI and Hepas, Lima, Peru. Background: - Proven effecve in 2011, oral HIV Pre-Exposure Prophylaxis (PrEP) was recommended by WHO for people at substanal risk in 2015. - PrEP adopon and scale-up remains insufficient globally, especially within naonal HIV prevenon programs. - Ongoing demonstraon projects are helping document and resolve difficules. - ImPrEP, conducted in Brazil, Mexico and Peru, is enrolling eligible MSM and transgender women (TW) aged 18 or older. - In Peru, we conducted an interim analysis of the PrEP implementaon at the 9 public study sites: HIV prevenon services in 6 priority cies. Methods: - We conducted 5 semi-structured interviews with health providers in three cies: Lima/Callao, Pisco and Pucallpa, to idenfy key issues in the implementaon. - We also analyzed the monitoring data of the PrEP implementaon process in the 9 public sites, to idenfy: basic exisng infrastructure and gaps as well as issues affecng enrollment and quality of care. - After having taken into account the issues at the implementation sites, meengs were held with local authories and health providers for the implementaon of the study at headquarters. - Then the training sessions were scheduled in each place and the acvies started once the process was finished. Figure 1: Sites where PrEP is being implemented. 1 MoH Hospital (Hospital La Caleta) 1 MoH Hospital (Hospital Regional de Trujillo) 1 MoH Hospital (Hospital Amazónico) 2 MoH Hospitals (Hospital Regional de Ica, Hospital San Juan de Dios de Pisco) 4 MoH Cinics (San José, Barton, Tahuantinsuyo Bajo, Caja de Agua) 1 Private (Inmensa) Figure 2: Monitoring visit to an PrEP implementaon site. Results: - While the Ministry of Health co-sponsored the study, facilies were free to choose to be included. The program generated interest among both providers and potenal users: including MSM/TW new to the public clinics, such as university students and people of higher income/education. - During the interviews, providers expressed concerns about work overload, post-study PrEP availability and drug resistance. Prior to implementaon, basic infrastructure gaps in each site were addressed (e.g. lab equipment, furniture, space renovation) in variable periods (from 3 to 9 months) dependent on each site’s internal procedures. - Once enrollment started, new bolenecks became visible: limited - mes for laboratory sample collecon (most sites); limited/unpredictable availability of physicians (5 sites), long waiting times (all sites). Morning working mes (5 sites) are too inconvenient for transwomen. Table 1 : Multidisciplinary team of the sites and dynamics of attention to population MSM / TW Pucallpa Ica Pisco Trujillo Chimbote Barton San Jose Caja de agua Tahuantinsuyo Bajo 1 physician 1 obstetrician 1 phlebotomist 1 psychologist 1 nurse 1 physician 1 obstetrician 1 phlebotomist 1 psychologist 1 nurse 2 physicians 2 obstetrician 1 phlebotomist 1 psychologist 1 physician 2 obstetrician 2 phlebotomists 1 physician 2 obstetrician 1 phlebotomist 1 physician 2 obstetrician 2 phlebotomists 2 physician 2 phlebotomist 1 psychologist 1 nurse 1 physician 1 obstetrician 1 phlebotomist 1 psychologist 1 nurse 2 physicians 3 obstetricians 3 phlebotomist 1 psychologist 1 nurse Clinic Hours: from Monday to Saturday in the mornings Clinic Hours: for the MSM / TW population it is only 3 times per week. The doctor is paid for by the study. Clinic Hours: from Monday to Saturday in the mornings. The doctor is paid for by the study. Clinic Hours: from Monday to Saturday in the mornings. The doctor is paid for by the study. Clinic Hours: from Monday to Saturday in the mornings. The doctor is only available 3 times a week Clinic Hours: for the MSM / TW population it is only 3 times per week Clinic Hours: from Monday to Saturday in the mornings Clinic Hours: from Monday to Saturday in the mornings Clinic Hours: from Monday to Saturday morning and afternoon Figure 3: Training of health providers prior to implementaon. Conclusions: - Providers and users of public facilies are interested in PrEP. However, well planned and sustainable PrEP roll-out in these public facilies would require an upgrade in the general condions of HIV prevenon services. - The study is succeeding in recruing people at relavely high risk, seronegave, who come to the service with interest in receiving PrEP, or for another purpose (e.g. to get an HIV test). - PrEP Implementaon offers the opportunity to invest in strengthening and revamping the overall programmac response to HIV in Peru and similar countries. Acknowledgements We would also like to acknowledge: IMPREP – Peru staff, all the CE - RITS and UAMP of the MINSA and muldisciplinary team. Contact: Dr. Carlos F. Cáceres, [email protected]
Transcript of TUPEC416: Challenges and Barriers to PrEP Implementation ...
TUPEC416: Challenges and Barriers to PrEP Implementation in Public Health Facilities in Latin America: Initial Lessons from the ImPrEP Demonstration Project in PeruCáceres CF1, Konda KA1, Calvo G1, Guanira JV1,2, Salazar X1, Nunez-Curto A1, Vargas S1,3, Lugo E1, Gutierrez X1, Huaman B4, ImPrEP Study Group
1Universidad Peruana Cayetano Heredia, Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Lima, Peru, 2 Investigaciones Medicas en Salud, Lima, Peru, 3 Universidad Peruana Cayetano Heredia, Sexual Health Laboratory, Lima, Peru, 4 Ministry of Health of Peru, HIV, STI and Hepatitis, Lima, Peru.
Background:- Proven effective in 2011, oral HIV Pre-Exposure Prophylaxis (PrEP) was recommended by WHO for people at substantial risk in 2015.
- PrEP adoption and scale-up remains insufficient globally, especially within national HIV prevention programs.
- Ongoing demonstration projects are helping document and resolve difficulties.
- ImPrEP, conducted in Brazil, Mexico and Peru, is enrolling eligible MSM and transgender women (TW) aged 18 or older.
- In Peru, we conducted an interim analysis of the PrEP implementation at the 9 public study sites: HIV prevention services in 6 priority cities.
Methods:- We conducted 5 semi-structured interviews with health providers in three cities: Lima/Callao, Pisco and Pucallpa, to identify key issues in the implementation.
- We also analyzed the monitoring data of the PrEP implementation process in the 9 public sites, to identify: basic existing infrastructure and gaps as well as issues affecting enrollment and quality of care.
- After having taken into account the issues at the implementation sites, meetings were held with local authorities and health providers for the implementation of the study at headquarters.
- Then the training sessions were scheduled in each place and the activities started once the process was finished.
Figure 1: Sites where PrEP is being implemented.
1 MoH Hospital (Hospital La Caleta)
1 MoH Hospital (Hospital Regional de Trujillo) 1 MoH Hospital (Hospital
Amazónico)
2 MoH Hospitals (Hospital Regional de Ica, Hospital San
Juan de Dios de Pisco)
4 MoH Cinics (San José, Barton, Tahuantinsuyo Bajo, Caja de
Agua)1 Private (Inmensa)
Figure 2: Monitoring visit to an PrEP implementation site.
Results:- While the Ministry of Health co-sponsored the study, facilities were free to choose to be included. The program generated interest among both providers and potential users: including MSM/TW new to the public clinics, such as university students and people of higher income/education.
- During the interviews, providers expressed concerns about work overload, post-study PrEP availability and drug resistance. Prior to implementation, basic infrastructure gaps in each site were addressed (e.g. lab equipment, furniture, space renovation) in variable periods (from 3 to 9 months) dependent on each site’s internal procedures.
- Once enrollment started, new bottlenecks became visible: limited ti-mes for laboratory sample collection (most sites); limited/unpredictable availability of physicians (5 sites), long waiting times (all sites). Morning working times (5 sites) are too inconvenient for transwomen.
Table 1 : Multidisciplinary team of the sites and dynamics of attention to population MSM / TW
Pucallpa Ica Pisco Trujillo Chimbote Barton San Jose Caja de agua Tahuantinsuyo Bajo
1 physician1 obstetrician1 phlebotomist1 psychologist1 nurse
1 physician1 obstetrician1 phlebotomist1 psychologist1 nurse
2 physicians2 obstetrician1 phlebotomist1 psychologist
1 physician2 obstetrician2 phlebotomists
1 physician2 obstetrician1 phlebotomist
1 physician2 obstetrician2 phlebotomists
2 physician2 phlebotomist 1 psychologist 1 nurse
1 physician1 obstetrician1 phlebotomist1 psychologist1 nurse
2 physicians3 obstetricians3 phlebotomist1 psychologist1 nurse
Clinic Hours: from Monday to Saturday in the mornings
Clinic Hours: for the MSM / TW population it is
only 3 times per week. The
doctor is paid for by the study.
Clinic Hours: from Monday to Saturday in the mornings. The doctor is
paid for by the study.
Clinic Hours: from Monday to Saturday in the mornings. The doctor is paid
for by the study.
Clinic Hours: from Monday to Saturday in the mornings. The doctor is
only available 3 times a week
Clinic Hours: for the MSM / TW population it is
only 3 times per week
Clinic Hours: from Monday to Saturday in the mornings
Clinic Hours: from Monday to Saturday in the mornings
Clinic Hours: from Monday to
Saturday morning and
afternoon
Figure 3: Training of health providers prior to implementation.
Conclusions:- Providers and users of public facilities are interested in PrEP. However, well planned and sustainable PrEP roll-out in these public facilities would require an upgrade in the general conditions of HIV prevention services.
- The study is succeeding in recruiting people at relatively high risk, seronegative, who come to the service with interest in receiving PrEP, or for another purpose (e.g. to get an HIV test).
- PrEP Implementation offers the opportunity to invest in strengthening and revamping the overall programmatic response to HIV in Peru and similar countries.
AcknowledgementsWe would also like to acknowledge: IMPREP – Peru staff, all the CE-RITS and UAMP of the MINSA and multidisciplinary team.
Contact: Dr. Carlos F. Cáceres, [email protected]
