New HIV prevention technologies are researched all the time at the Desmond Tutu HIV Foundation. Often, scientists are concerned with how the people using these products will respond to them. But, equally important, is the response from the healthcare workers prescribing them. Robina Momanyi, an IAVI fellow visiting the Desmond Tutu HIV Foundation from Kenya, enlightened us on how health care providers (HCPs) are responding to new advancements in HIV prevention technology.
Currently, there are 35 million people living with HIV, and South Africa has a large burden; 6.3 million, of these cases. Clearly, there is still a need for preventative technology and getting HCPs on board with the newest prevention tools is essential to reducing this burden. These new technologies include the already rolled-out PrEP (Pre-Exposure Prophylaxis), as well as products not yet on the market: microbicides (a lubricant with a compound that prevents HIV infection) and vaginal rings (a short-term silicon ring inserted into the vagina that releases a drug to prevent HIV).
Momanyi conducted small focus groups and in-depth interviews with HCPs to discover how well they knew these new products and the possible barriers and facilitators to their roll-out.
Most of the HCPs did not know much about the new preventative technologies. This is useful to know when devising outreach strategies for these new products once they can be prescribed. However, the interviewees embraced the products and emphasised that they will prescribe them if research shows they prevent HIV.
The HCPs were enthusiastic about the recent HIV prevention drug: PrEP (Pre Exposure Prophylaxis), a once a day pill of HIV-negative people at risk of infection. They noted that there would need to be a careful strategy for its roll-out. The PrEP program needs a new distribution infrastructure: PrEP-takers need repeat prescriptions and require an HIV test every three months. This prevention method is extremely effective so it is essential that it is known in the community.
Ideally, a long-acting vaccine would be the HCPs preferred prevention method: a one-time injection puts less strain on healthcare providers and there is less hassle for users. It can be easy to forget to take a daily pill and not everyone has places they can put pills discreetly. A vaccine would also get rid of the need for secrecy for PrEP users who prefer to keep their medication-use private.
Overall, the HCPs had competing interests about the roll-out and sustainability of these new prevention technologies. They indicated that there was a need for an education plan about the products as their willingness to prescribe depended on what and how much they knew. They also mentioned that there is a need for sensitivity and consideration on how their clinic community viewed the need for HIV prevention when considering the new products.
HCPs had the opinion that more community education was needed on proper and consistent use of condoms as they are 99% effective, then to promote other prevention technology. However, they also observed that new technology with less user-adherence would be more successfully used by consumers, so they were interested in the promotion of prevention that did not require daily commitment.
The next step will be more discussion, empowering providers with training and guidelines when we think about roll out. Willing users aren’t the only obstacle, we also need willing providers.
We are grateful to Momanyi for her fascinating and thought-provoking research and wish her luck as she moves onto the next stages of her career.