BACKGROUND: Oral pre-exposure prophylaxis had high initial uptake with select populations in Zambia following introduction in 2018. However, achieving PrEP uptake at progressively greater scale remains challenging. The USAID Zambia Integrated Health project aims to improve PrEP use through status-neutral testing approaches across priority populations.
DESCRIPTION: We assessed factors contributing to low PrEP uptake and current use, which were limited provider knowledge leading to hesitancy to provide services and limited PrEP integration with activities that include HIV testing services (HTS), and collaboratively developed microplans with Ministry of Health (MOH) district health officers and facility managers in Central and North-Western provinces. Microplans included technical mentorship of facility and community providers, promotion targeting facilities and communities, and strengthened linkages for rapid PrEP start. We compared program data between July to November for 2022 and for 2023 to assess change while considering potential PrEP seasonality.
LESSONS LEARNED: PrEP uptake markedly increased, largely attributed to increased promotion among pregnant and breastfeeding women and, for men, via voluntary medical male circumcision (VMMC) between years. We attribute these increases to three factors. First, mentorship improved provider confidence for PrEP counseling, prescribing, and management, particularly within antenatal and postnatal care and for generating HTS and PrEP demand within communities. Next, PrEP services were newly integrated with other prevention activities, particularly VMMC, with direct or facilitated referral for rapid PrEP start. MOH guidance to integrate PrEP with other services acted synergistically with mentorship to motivate providers. Last, the project supported strengthened PrEP documentation for relevant facility staff. During implementation, the PrEP and HTS commodity supply chain was stable with no stock-outs.

CONCLUSIONS: Expanded provider and community-based volunteer mentorship and HIV prevention service integration have successfully increased PrEP uptake in two predominantly rural Zambian provinces across five months. The project will explore further adaptations and improve documentation to expand uptake and prevention-effective use.