BACKGROUND: Since its introduction in 2017, the uptake of PrEP in the Philippines has reached >10,000 individuals. With the rate of HIV transmission experienced by the country, other models to effectively roll-out PrEP are urgently needed. Barriers in PrEP uptake include challenges to service access, further highlighted by limited mobility caused by COVID-19. Here we introduce an all-virtual, community-led PrEP program for MSM using a demedicalized approach.
DESCRIPTION: MSM clients who reported HIV-negative in a online unassisted HIV self-testing program were offered their interest in PrEP. A blood-based self-test kit is sent to their delivery address, and are guided with instructions-for-use and result reporting. Once marked HIV non-reactive, a self-assessment tool is sent to determine their sexual behavior and the presence of the following: acute retroviral syndrome, kidney-related morbidity, and supplementation. These information are then validated by trained community peers, and are provided PrEP information and counseling via telemedicine. Once assessed and marked eligible, the client is sent one PrEP bottle, another self-test kit, and a QR code for their refill instructions delivered via courier within 3 days. For follow-ups, the client uses the received self-test kit and reports the results. Once marked HIV non-reactive, the client is sent one self-test kit with PrEP bottles relative to the number of their visit. The demedicalized process is detailed in Figure 1.


LESSONS LEARNED: Between August and April 2023, 230 clients were initiated with PrEP, which translates to 10.44% (of 2203 clients) who reported HIV-negative via the all-virtual HIV self-testing process. 100 clients (43.48%) have completed their first monthly visit, with 92 clients reported taking PrEP daily.
CONCLUSIONS: This program provides evidence that an all-virtual, community-led and demedicalized PrEP approach integrated with unassisted HIV self-testing is possible. Further demand-generation and other offline-based key-population-friendly activities will be done to increase awareness and enable access to more clients.