Special issue on Sexual and Reproductive Health and Rights Services and HIV: call for papers

You are invited to submit to a special supplement issue on the Integration of Sexual and Reproductive Health and Rights Services (SRHR) and HIV Prevention, Treatment, and Care Services across Sub-Saharan Africa. Selected papers will be published in BMC Infectious Diseases, BMC Public Health and Reproductive Health. Full details, including how to submit manuscripts, can be found here.

PrEP’s Entry into Kenya: Communities hold the key

On July 4, Kenyan civil society, including groups working on the frontlines of HIV prevention and treatment, called a meeting with the leaders and implementers of oral pre-exposure prophylaxis (PrEP) activities in the country. The meeting’s purpose was to have a frank discussion about the role of community support in the national PrEP program, and touch on progress with HIV self-testing implementation. Some of the civil society groups, like ISHTAR-MSM and Bar Hostess Empowerment Support Programme (BHESP), are also involved in implementation—they’ve partnered with Jilinde, a national-scale PrEP rollout project, or LVCT to help identify potential PrEP users, spread messages and deliver services.

Other CSOs in the room, such as Survivors, an NGO of female sex workers in Busia, Western Kenya, and the Kenya Legal & Ethical Issues Network on HIV and AIDS, aren’t delivering services, but, like BHESP and ISHTAR, represent advocates, activists and potential PrEP users. All were united by a common goal of shining a spotlight on community and civil society engagement as a critical link to successful PrEP rollout in the country.

In the months leading up to the May 4 launch of Kenya’s national program, many civil society groups gave inputs to the national PrEP technical working group (TWG), convened by the National AIDS & STI Control Program (NASCOP). This work is ongoing, with civil society represented on the various rollout committees.

But being invited to the table is not the same as setting the table—and at the July 4 meeting, the organizers structured a packed agenda in order to learn about progress and plans, as well as to express their views on priority issues.

Rosemary Mburu, Executive Director of WACI Health, and Nelson Otuoma, Executive Director of the National Empowerment Network of People living with HIV/AIDS in Kenya (NEPHAK), co-facilitated the meeting.

Mburu noted that many issues remain to be worked out if PrEP is to achieve its true potential in the country: communities need to be continuously informed and engaged; sustainable financing that includes domestic resources has to be secured; and county-level plans have to be designed, with appropriate material for use at the community level.

Otuoma, who recently won the inaugural Maisha Conference Award for his work in community advocacy, reminded everyone of PrEP’s massive potential in Kenya, but only “if we can overcome barriers like stigma.”

“Just like ARVs changed the face of HIV from a killer disease to a chronic condition, PrEP can help the country move further and faster along the HIV prevention roadmap,” he said.

Jointly presenting the viewpoint of young women to the convening, 24-year-olds Anastacia Kendi and Grace Kamau, part of the youth-serving group Sauti Skika, welcomed the launch of PrEP, calling it “an empowering tool to women and girls.”

“I hope there will be more investments in ensuring the interventions are made to work for women and girls’ needs alongside the needs of boys and men.”

Three established PrEP implementation projects in Kenya—the Partners Scale Up Project; Introducing PrEP in Combination Prevention (IPCP); and Bridge to Scale (also known as Jilinde, Kiswahili for “protect yourself”)—shared updates and lessons learned.

Speakers from these projects reported excitement about PrEP as a new prevention method in the country. Yet they said that there were obstacles when it comes to actual use. While there are reports of high demand in some communities and programs, there are also places where the number of people signing up to use PrEP is lower than the expected enrollment.

Adherence (taking the pill daily as prescribed) stands out as challenge; and many people who are using PrEP have been “lost to follow-up”, public-health lingo for a participant who starts taking a medication such as PrEP or antiretroviral treatment (for people living with HIV) but along the way stops returning for their monthly refill visits without informing their clinic.

In all updates, community engagement stood out as a critical part of the solution.

Dr Elizabeth Irungu, the director of the Partners Scale Up Project in Thika and Kisumu in central and western Kenya respectively, said the project team is finding broad acceptance for PrEP among heterosexual, HIV-serodiscordant couples.

“We now have something to give the HIV-negative person,” she stated.

Partners dispenses PrEP from Comprehensive Care Centres (CCCs), clinics that are primarily involved with HIV prevention and treatment.

“We think that by adding PrEP for HIV prevention for HIV-negative people, there may be a reduction of the stigma associated with going to CCCs, as both positive and negative people can get services there. However, there is a lot of work to be done to reduce stigma around HIV, and around going to a CCC,” said Irungu.

By June 2017 the project, funded by the Bill & Melinda Gates Foundation, had enrolled 290 couples. They hope to reach 4,800 couples by 2019—200 in each of 24 centers.

Jhpiego’s Jilinde project, also funded by the Gates Foundation, is working among men who have sex with men, sex workers and adolescent girls and young women at high risk for HIV.

Tom Marwa, Senior Technical Advisor at Jhpiego, informed the convening that 2,300 users were enrolled between February and June 2017 through 17 Jilinde PrEP delivery centres in 10 counties of Kenya. The program is on track to reach 20,000 PrEP users by 2020, and its experiences will contribute important lessons to other African countries planning to introduce PrEP, he added.

Introducing PrEP in Combination Prevention (IPCP) consortium, led by LVCT Health, is implementing PrEP among the same populations as Jilinde. The project started before the national launch of PrEP and was designed to test whether PrEP could be delivered to these populations from standard healthcare facilities.

Dr Michael Kiragu, who leads IPCP, said he was heartened to see good support of PrEP during the formative studies phase of the project. Yet out of a target of 2100, only 1626 PrEP users (77 percent of target) were enrolled and retained into the program. He said that this was a sign that there were barriers to PrEP uptake and use.

The project team has learned that an individual’s community has a huge influence on their decision-making, and stigma remains a barrier to PrEP uptake and adherence, he noted.

“PrEP users at IPCP clinics complain about the rattling of pills in the bottle, the color of the pill (blue), and about disapproval from their husbands, boyfriends or parents.” To address some of these challenges clinics have started giving out cotton balls to mute the rattling of pills, holding community dialogues on PrEP with men, and offering couples counseling. In addition, people using PrEP have pointed to support groups as one of the most important resources they depend on to help them maintain good adherence.

Dr Sarah Masyuko, NASCOP’s HIV testing and PrEP Manager, gave a keynote at the convening.

The first phase of communications and advocacy on PrEP had been hugely successful, she noted, with widespread media and social media engagement reaching all corners of the country. On the sustainability question raised by civil society, Dr Masyuko said the Ministry of Health is holding consultations with PEPFAR, The Global Fund, and private companies in Kenya to secure long-term financing for PrEP.

“PrEP rollout is unlike any other,” she noted, citing difficulties with gathering reliable data for an intervention that people can get on and off at will. She said the government is looking into an electronic system with unique identifiers that will help better track users nationwide. She challenged implementing partners to do even more to reach communities with accurate messages on PrEP and HIV self-testing, and that dispel rumours and misconceptions that stand in the way of uptake among eligble persons, defined in the Kenya national guidelines as anyone at substantial ongoing risk of HIV infection.

This background information provided the platform for a robust discussion of what’s working—and what else is needed. Civil society representatives were clear that PrEP messages needed to be highly tailored and that organizations with different positions in the communities needed to have the right infomation to deliver through trusted channels. This could mean fine-tuned messages that go beyond the category of “adolescent girl or young woman,” “sex worker,” or “MSM” to consider other life circumstances—how openly a person is living with his or her identity, their community support, their influencers, et cetera. Some of this work is underway; much more will come from civil society groups leading work on the ground and feeding back on what works and what doesn’t.

From the convening, Peter Mogere, lead pharmacist at the Partners Scale Up Project and 2017 AVAC Fellow, presented a 9-point list of ‘Civil Society Asks’ to the National Technical Working Group (TWG) on PrEP, on 7 July. Along with allocating domestic resources for PrEP, the asks focus on community engagement at the grassroots level; health care provider training; and combating human rights violations, stigma and discrimination.

Mogere said the TWG was highly receptive to the civil society asks; “The TWG Chair said she was looking forward to involving the civil society in reaching out to all communities that would benefit from PrEP. She noted that civil society works on the ground in all regions of the country, including rural areas, and reaching all people at risk of HIV infection is high on the priorities of the national PrEP program.”

As a next step, the advocates are planning to stay connected and to develop and advance priorities that they can pursue through meetings where civil society sets the agenda. The history of the epidemic tells us this is how things change.

AVAC provided technical and financial support for the convening, which was co-hosted by AVAC partners WACI Health and the National Empowerment Network of People living with HIV/AIDS in Kenya (NEPHAK), in collaboration civil society organizations ISHTAR-MSM; Survivors; International Network of religious leaders living with or personally affected by HIV (INERELA+)-Kenya; National Organization of Peer Educators (NOPE); I Choose Life; Health Gap; Bar Hostess and Empowerment Programme (BHESP); Keeping Alive Societies Hope (KASH); Persons Marginalized and Aggrieved (PEMA); Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN); and Sauti Skika, a project affiliated with NEPHAK.

Announcing the Call for 2018 Advocacy Fellows

UPDATE: We are no longer accepting applications.

AVAC is pleased to announce the call for applications for 2018 Advocacy Fellows. Consider applying to be an Advocacy Fellow and join the 56 Fellows and alumni of the program!

This update provides information on the Advocacy Fellows program, the application process, link to a short informational video and details on an upcoming informational call for interested applicants to be held on Thursday, 10 August 2017.

The submission deadline for Advocacy Fellows applications is Friday, 8 September 2017.

Download application materials at www.avac.org/fellows-application-materials.

About the Program

AVAC’s Advocacy Fellows program was launched in 2009 with the goal to support and expand the capacity of advocates and organizations to monitor, support and help shape biomedical HIV prevention research and implementation worldwide. The program is guided by AVAC’s conviction that effective and sustainable advocacy grows out of work that reflects organizational and individual interests, priorities and partnerships.

The Advocacy Fellows program provides support to emerging and mid-career advocates to design and implement advocacy projects focused on biomedical HIV prevention research and implementation activities in their countries and communities. These projects are designed to address locally identified gaps and priorities. Fellows receive training, full-time financial support and technical assistance to plan and implement a targeted one-year project within host organizations working in HIV/AIDS or related advocacy. Host organizations are critical partners in the program and Fellows’ projects can be an opportunity for an organization to further develop its own work in this field.

The Fellows program focuses on low- and middle-income countries where clinical research on new biomedical HIV prevention options (such as long-acting PrEP, microbicides, multi-purpose prevention technologies, vaccines and related strategies) is planned or ongoing; sites of cure research; or where there is implementation or plans for rollout for proven interventions (such as voluntary medical male circumcision, PrEP, treatment on demand, high impact combination prevention packages) and where there is exploration of strategies for integration of HIV and sexual and reproductive health to reduce risk.

HIV Prevention Research Advocacy Fellows are:

  • Emerging or mid-career community leaders and advocates involved or interested in advocacy around biomedical HIV prevention research and implementation.
  • Individuals with some experience or education in the areas of HIV and AIDS, public health, international development, women’s rights, communications and/or advocacy with key populations, such as adolescent girls and young women, sex workers, gay men, other men who have sex with men and transgender women and people who inject drugs.
  • Based in low- and middle-income countries where biomedical HIV prevention clinical research is planned and/or where implementation of combination prevention packages is planned, ongoing or emerging.
  • Able to collaborate with English-speaking mentors.

Please visit www.avac.org/pxrd to identify countries where research and implementation is ongoing or planned and to learn more about the research. For a list of ongoing trials, visit www.avac.org/summary-tables.

Learn More

Prospective applicants or host organizations who want to learn more about this program or have questions about the application process are encouraged to:

Register for the call here.

If you have any questions about the Fellows program or the application process, please email fellows@avac.org.

Applications are due by FRIDAY, 8 SEPTEMBER 2017.

Please share this information with your partners, and we look forward to receiving your application!