Something revolutionary in HIV prevention is happening in Central Africa. Pre-exposure prophylaxis (PrEP) is being implemented for the first time in the Democratic Republic of Congo (DRC).
People at on-going, substantial risk of HIV infection are offered PrEP — the use of antiretroviral drugs (ARVs) by HIV-uninfected persons to prevent the acquisition of HIV — as part of a combination approach to HIV prevention. This includes regular HIV testing, promotion and provision of condoms, screening and management of sexually transmitted infections, adherence support, and risk-reduction counseling.
ICAP is collaborating with the DRC Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC) to offer PrEP at seven health facilities in Kinshasa and Lubumbashi — DRC’s two largest cities — through a CDC Global Technical Assistance award funded by the President’s Emergency Plan for AIDS Relief (PEPFAR).
“We don’t have a lot of data on the use of PrEP in resource-limited settings, so we are very excited to learn from this experience and to understand how HCW [health care workers] feel about providing PrEP and how clients feel about taking daily medications to lower their risk of acquiring HIV infection,” notes Dr. Elaine J. Abrams, professor of epidemiology at Columbia University Mailman School of Public Health, ICAP’s senior research director and principal investigator of the Global Technical Assistance project. “We know even less about attitudes toward, satisfaction with, and barriers to PrEP in these settings, so this evaluation will provide critical information that should inform the national programs as they plan to implement and scale up PrEP services, and point the way to bringing PrEP to more people in the country.”
[Photo: Dr. Elaine Abrams]
The initiative is focused on planning, designing, and implementing PrEP services for key populations in DRC, including sex workers, men who have sex with men, transgender persons, and people who inject drugs. Key populations are at an increased risk of contracting HIV.
“I run risks every single day,” said one sex worker who is receiving PrEP at the Lubumbashi clinic. “Because PrEP is effective, it will give me extra protection against HIV, and allow me to do my job safely.” The introduction of PrEP is also empowering for health care workers who serve key populations. “I’m honored and proud to be one of the first health care workers to provide PrEP in the DRC,” said a health care worker at the Edith Cavell Clinic in Kinshasa. “It’s a good feeling because it shows that we are fighting HIV in all ways.”
ICAP began working in DRC in 2010 on a CDC project to support HIV prevention, care, and treatment services at health facilities in Kinshasa and Katanga provinces, in partnership with the National HIV Control Program, National Tuberculosis Program, National Reproductive Health Program, and the National AIDS Reference Laboratory. Currently, ICAP supports community- and facility-based HIV services tailored to the needs of key populations in Kinshasa and Haut Katanga, including psychosocial support and mobile testing and referrals.
All ICAP-supported facilities in DRC provide the full package of HIV prevention, care and treatment services, including HIV testing, prevention of mother-to-child transmission, integrated tuberculosis and HIV care, and support for survivors of sexual and gender-based violence. The lessons learned and partnerships resulting from this experience informed ICAP’s launch of PREP services.
ICAP plans to conduct an in-depth evaluation of the new PrEP services at all seven sites, assessing PrEP patient screening, eligibility, uptake, and retention outcomes, as well as the feasibility and acceptability of PrEP among both patients and providers. ICAP will share the findings with stakeholders at dissemination meetings, and plans to publish results in peer-reviewed journals to inform and advance PrEP implementation in sub-Saharan Africa and beyond.