Phases of Informed-Choice PrEP Counseling

This flow chart emerged from socio-behavioral research, including surveys and in-depth interviews with Kenyan and South African women. The research team set out with the goal of adapting the informed-choice approach used in family planning programs for use in PrEP, a prime example of fields learning from each other. The result is very clinic-centered; AVAC has added the column at the far right to reflect additional elements. However, it is a step towards much-needed exploration of how to make informed choice a reality in HIV prevention today.

Putting Women at the Center: Informed choice in 2018 and beyond

We need to give women the choice to use DTG or not and to use contraception if indicated and desired. We need to support choices across options, with risk reduction—not use of a specific product—as the primary outcome. We need to give women the choice to use DMPA-IM or –SC or not, and to use HIV prevention as desired.

No Prevention, No End – AVAC launches new report and call to action

Today AVAC released No Prevention, No End, our 2018 annual report on the state of the field. Starting from the title—which humbly borrows the cadence of the call for an end to state-sanctioned violence against Black Americans, “No Justice, No Peace”—through to the closing words, “This is the worst possible moment for slowing down,” the Report is a call to action and guide for addressing the HIV prevention crisis that threatens progress in curtailing epidemics worldwide.

Click here to download the Report and individual sections and graphics; click here for a new episode of the Px Pulse podcast which covers the Report’s key themes and features lead author Emily Bass, AVAC’s Director of Strategy and Content.

UNAIDS named the prevention crisis in its July 2018 report, Miles to Go. It acknowledged that the scale-up of antiretroviral treatment, while essential, is insufficient as a prevention strategy. AVAC has been warning of an imbalance in approaches and investments across approaches, and calling for ambitious targets matched with political will, financing, timelines and more since the UNAIDS targets were first launched in 2014. (Check out AVAC Report 2014/5: Prevention on the Line for a summary of this critique of targets.)

In this year’s Report, we call out three core problems with primary prevention and the global HIV response, identifying the risks they bring and the path to a solution. Specifically, we focus on:

  • Investing in demand creation: The private-sector gloss on this term cannot obscure its essential role in making primary prevention work. Strategies that might save lives are condemned as unwanted or unfeasible when they’re delivered in programs that lack integrated demand-side thinking, which is a science and not a set of slogans.
  • Making informed choice central to HIV prevention: Programs that offer more than one option, along with a supportive environment for a provider and client to discuss risks, benefits and personal preferences aren’t a luxury but a necessity. The family planning field has metrics to measure choice; HIV should pick these up, with prevention programs leading the way.
  • Unstinting radical action: Progress in the global AIDS response is tenuous; so is the state of democratic institutions and the future of the planet. These interconnected issues require more bold action, including from countries that are aid beneficiaries, and from the citizens of those countries who unite to hold truth to power. In the HIV prevention context, this means accountability for primary prevention at every level, including research for next-generation options.

AVAC is launching this Report as many stakeholders in HIV prevention research gather in Madrid for the HIV Research for Prevention (R4P) conference. Visit our special R4P page to find us on-site and follow along from afar, to see how the themes of this year’s Report resonate in a global and wide-ranging discussion of HIV prevention research and implementation at a critical time.

PrEP Messaging: Using radio to reach communities with oral PrEP messages

This story is part of a series of reports from the ongoing POWER Study, which is developing cost-effective and scalable models for PrEP delivery in Kenya and South Africa. AVAC and the University of Washington (UW) have teamed up to help answer questions from implementers rolling out PrEP in a variety of settings. Using qualitative stories from the UW PrEP projects, these blogs share lessons learned from the field and actionable insights for implementers developing strategies for delivering PrEP.

Joel Odondi must be doing something right. The former chaplain for a girls’ school has become a trusted expert on HIV prevention to radio listeners across Kenya – delivering messages that correct misinformation, counter myths, explain scientific concepts, and frame public health debates on PrEP and a host of other issues related to HIV. Keeping an ear out especially for what young women need to hear, Odondi uses a powerful combination of responsiveness, accuracy and credibility to get the job done.

Joel Odondi on the mic

It started ten years ago, when Odondi turned to a local radio station in Kisumu to get out messages about PrEP. The idea was to inform the community about research going on in their backyard on a new HIV prevention intervention, PrEP, and enroll people in the study, known as Partners PrEP, which also sponsored the show. Since that launch, the show was popular enough to continue through the open label extension study, demonstration study, and scale up program that is part of national roll out.

At the time, Odondi was part of the Partner’s PrEP team in Kisumu. It was a phase III placebo-controlled trial of daily oral TDF or TDF/FTC as PrEP for the prevention of HIV among heterosexual men and women in sero-discordant partnerships in Kenya and Uganda. Odondi saw that the providers and the scientists had developed a strong program to explain the study and how PrEP works. But that wasn’t enough.

Download a tool for radio engagement written by Odondi

“Those messages were not reaching the rural women, the village girls and that was a problem. Among other things, they needed information in their own language, Luo. I lost my sister to HIV and it was important to me to find a way to help make someone’s life better. I wanted to address issues of stigma and combat those myths with facts.”

Odondi started at two Luo speaking stations with hour-long shows where he would talk about PrEP, how it worked and who it was for. He talked about knowing your status and connecting with services. He confronted myths about the research process. He talked about why young people are vulnerable to HIV exposure. He talked about condom use, abstinence, voluntary medical male circumcision, morality and public health, and the importance of protecting young people as an investment in the future.

“Many of the participants [in PrEP demonstration projects] come from rural areas. It’s a challenge to get information to them. But they listen to the radio. And the radio gives you a kind of celebrity. It’s a kind of authority.”

Ten years later, Odondi is the Community Liaison Officer for the POWER study (Prevention Options for Women Evaluation Research) and the Lead Technical Advisor for Community Outreach for the Partners Scale-Up project operated out of KEMRI (Kenya Medical Research Institute). As part of his work on these projects, he has 18 shows a month on six different stations in three languages, Luo, English and Swahili, including stations in Nairobi that are heard across Kenya. Through all these stations his shows reach millions.

Each show starts with a 20-minute discussion between him and a station host on a prepared subject, the rest of the hour they open the phone lines and answer questions. The phone lines routinely fill up and stay full through the hour. His prepared remarks come from material he gets from the community through a couple of channels: he holds weekend workshops where he provides HIV prevention information to young women and they write down questions for him; the stations give their listeners a phone line where their questions and concerns are recorded for Odondi to review in advance of a show; and he provides a help line number over the air and promises that someone is always available to answer.

People call. A lot. Odondi is able to provide them with information about where to get PrEP in their area which has led to increased enrollments in both the POWER study and Partners Scale Up project.

“The same questions come up. The young people want to know if they are eligible to take PrEP. They want to know the side effects, if they have to take it forever, could they get an injection instead. Religious leaders ask me if PrEP will be abused, if it promotes promiscuity. One called into a show to say HIV was God’s punishment. I said ‘No. This is a health issue.’ When they bring the religious point of view, I can bring in a new point of view, a research literacy point of view.”

Sometimes he shapes his radio program based on new findings from the clinics he works with in his role in POWER and the Partners Scale Up project. “We saw a gap in HIV testing. So the station promoted my next show on the topic of testing with short spots on ‘What to do if you’re positive’ and ‘What to do if you’re negative’.”

When it comes to reminding people to take PrEP every day there are a few analogies he turns to again and again. “PrEP works if you take it. It’s the same if you want security — you have to lock your door every day. Condoms don’t work in your pocket. Wear a seatbelt every day for that one day you are in an accident.”

Odondi takes extra care in his messages to young people. He says it’s a real mistake to assume you know what they need. He attends community discussions about PrEP and listens to the voices of young women to stay up to date. But some parts of his message don’t change. “First I tell them they are special, their energy and spirit is our future. Then I tell them they [young women] are vulnerable and talk about condoms and sexual health and other risks. Finally, I tell them ‘you can be part of the solution,’ and invite their ideas. And then I listen.”

Additional Resources

  • Odondi has authored this brief outline on the benefits of radio as a tool for community engagement, complete with highlights of commonly asked questions and topics he covers.
  • Hear Joel Odondi explaining PrEP on the radio airwaves of KBC English, a Kenya-based news service.

logos for USAID, PEPFAR, and POWER

POWER (Cooperative Agreement AID-OAA-A-15-00034) is made possible by the generous support of the American people through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the United States Agency for International Development (USAID). The contents do not necessarily reflect the view of USAID or the United States Government.

Oral PrEP Enrollment Snapshot

For trends in oral PrEP uptake, check out the Oral PrEP Enrollment Snapshot. This PowerPoint deck illustrates major findings from the tracker with heat maps showing where people are initiating PrEP, updates against targets and more. A PDF version is also available.

PrEP Initiations by Country in Africa

AVAC tracks global PrEP use by conducting quarterly surveys of ongoing oral PrEP demonstration and implementation projects, and collecting data from manufacturers and government agencies. This graphic shows data on PrEP initiations in Africa. For more trends in oral PrEP uptake, check out the Oral PrEP Enrollment Snapshot slide deck and visit PrEPWatch.

A Global Look at PrEP Introduction

The introduction of PrEP took many years to reach current levels of acceptance and availability. The next phase of distribution is on track to move faster. This is an updated version of a graphic appearing in AVAC Report 2017: Mixed messages and how to untangle them.

Map of HIV Prevention Research and PrEP Demonstration Sites in Kenya

This map demonstrates the breadth of HIV prevention research and demonstration projects in Kenya by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Malawi

This map demonstrates the breadth of HIV prevention research in Malawi by site and type (e.g. ARV-based vaginal rings, long-acting injectable PrEP, preventive Vaccines, antibodies). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Uganda

This map demonstrates the breadth of HIV prevention research and demonstration projects in Uganda by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.