BACKGROUND: Zimbabwe has made significant progress towards HIV epidemic control, with a 70% reduction in new HIV infections since 2010. However, key populations (KPs), including men who have sex with men (MSM) continue to contribute a significant proportion of new HIV infections relative to their population size. Oral Pre-exposure prophylaxis (PrEP), which is highly effective in reducing the risk of HIV infection, is recommended for all people at substantial risk in Zimbabwe. Following the guidance from WHO, we implemented a pilot project This intervention was to assess the feasibility and acceptability of delivering event driven PrEP (ED-PrEP) to prevent HIV among MSM in Harare, Zimbabwe
METHODS: A cohort study was conducted from November 2022 to April 2023. Qualitative and quantitative data was collected to assess feasibility, acceptability, client and provider experiences and outcomes among clients testing HIV negative who were assessed for risk, counselled and offered a choice of daily oral PrEP (D-PrEP) or ED-PrEP. Patterns of use and outcomes such as continuation on PrEP, incidence of sexually transmitted infections and adverse events were assessed by providers during the quarterly visits and by peers through mobile based platforms. Focus group discussions and in-depth interviews were conducted using a semi-structured questionnaire to explore experiences.
RESULTS: A total of 196 MSM were initiated on PrEP in the six months of implementation (19 D-PrEP; 177 on ED-PrEP). At initiation, 60% (106) of the clients switched from D-PrEP to ED-PrEP citing infrequent events and reduction in pill burden whilst 10% switched back to D-PrEP citing unplanned events. Continuation was significantly higher among ED-PrEP users, 87.5% vs 12.5% at month 1 and 74% vs 26% at month 3. No adverse events were recorded; Forty-four percent (44%, 69) preferred ED-PrEP. Incidence of STIs was at 7% (13). No seroconversions were recorded.
It is feasible to deliver ED-PrEP as an additional HIV prevention method for MSM. Clients can also switch from one method to another based on their prevention needs and preferences.