Mfochive Njindam Iliassou
Johns Hopkins University, Cameroon
Title: Characterizing strategies to optimize Pre-exposure Prophylaxis (PrEP) uptake and retention among key populations (men who have sex with men (MSM) and female sex workers (FSW)) in Cameroon
Biography
Biography: Mfochive Njindam Iliassou
Abstract
Background: In Cameroon, key populations (KP) have consistently been shown to be disproportionately affected by HIV and the rate of new infection is significantly high among them. In June 2019, Cameroon launched PrEP implementation through community-based organizations (CBO) for KP.
Method: Since June 28th, 2019, five CBOs in Yaoundé and Douala have been offering daily oral PrEP to KP. Peer-leads monitor clients on PrEP with follow-up done at first visit, one month and every three months thereafter. PrEP uptake and retention were assessed at 3 and 6 months. Throughout implementation, qualitative data were collected to inform strategies to improve uptake, retention and mitigate challenges.
Results: From June 28th to December 31st, 2019, 5,779 KP were approached in the community and sensitized on PrEP among whom 980 (17%) [MSM (40%); FSW (60%)] potential PrEP candidates arrived at DIC and screened for HIV risk behavior. 554 (57%) with high risk behavior and consented, were offered biological testing (HIV, syphilis, hepatitis B and kidney function). 511 (91%) were found eligible and offered PrEP of whom 283 (54%) [MSM (64%); FSW(36%)] were initiated. 186 (66%) [MSM (80%); FSW (20%)] were retained on PrEP as of December 31st.
PrEP uptake increased from 53% (208/390) to 82% (75/91) among eligible candidates in June-September and October-December 2019, respectively. Three-month retention also improved from 53% (208/390) to 80% (60/75) in the same periods.
Qualitative themes that of emerged barriers included low HIV risk perception, potential resistance to PrEP use in the community, anticipated PrEP-stigma due to conflation of PrEP and antiretroviral therapy, preference for on-demand PrEP which is not nationally approved, perception of little incentive by PrEP users to attend their regular appointments.
Conclusion: Encouragingly, there have been significant improvements in PrEP uptake and retention between successive quarters of implementation. These successes have been attributed to a broad coalition supporting PrEP implementation including the government, USAID, CBO leadership, peer-leads, social influencers, and PrEP users. Collectively, this group has addressed ongoing and emergent challenges in real-time in Cameron by evaluating implementation data, facilitating enhanced capacity of peer-leads to use SOPs, and constantly adapting in-person and online PrEP messages to address mistrust.