“The first time I heard about PrEP was through Quelimane FM radio. Days later, I received a visit at my house from a Prevention Champion who also talked to me about it and explained a bit more of what PrEP was. After the explanation he gave me about PrEP, he invited me to go to the health facility where I could talk with the SAAJ nurse for more information and understand if I was eligible to receive it.” Amélia Vasco is a 23-year-old living in Quelimane District and a new beneficiary of PrEP (Pre Exposure Prophylaxis) services.
A total of 10,202 people initiated PrEP at FGH-supported health facilities during the reporting period (Q1 COP22), an impressive 69% increase compared to the prior reporting period (6,046 in Q4 COP21).
In 2015, the World Health Organization recommended PrEP as an additional prevention option for people at risk of HIV infection and it was first implemented in Mozambique in October 2017. PrEP is part of a combination prevention strategy being implemented in Mozambique with the objective of reducing new infections and reaching epidemic control by 2030.
In Zambézia Province, PrEP services were first offered in March 2018 in 18 health facilities in 10 districts. The number of health facilities offering PrEP gradually grew as part of a coordinated effort made by the provincial health authorities with the support of FGH. Recently, an additional 26 supported health facilities began offering PrEP, so that by the end of 2022 (Q1COP22), FGH was providing direct support to PrEP services at 92 health facilities across 18 districts.
PrEP is offered to individuals 15 years of age or older who have a negative HIV test result and are at a higher risk of being infected by HIV, including serodiscordant couples, adolescents and young people between 15-24 years of age, key populations (men who have sex with men, female sex workers, prisoners, and people who inject drugs), as well as pregnant and lactating women, and men older than 25 years of age in settings with a high HIV prevalence.
PrEP access among adolescents and young people between 15-24 years of age, such as Amélia Vasco, has increased in FGH-supported health facilities. Sixty-one percent of the 10,202 people initiating PrEP in Q1 COP22 were adolescents and young people, and 73% initiated PrEP in health facilities within FGH-supported districts implementing the DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) strategy. In coordination with the FGH DREAMS team, a referral standard operating procedure (SOP) has been implemented to ensure that eligible Adolescent Girls and Young Women (AGYW) were referred from School Health Corners to receive health testing services within the Adolescent Friendly Services sector (SAAJ) at the health facility and offered PrEP. Prevention Champions, AGYW volunteers that work at schools in coordination with the counselors stationed at the School Health Corners were trained on the PrEP demand creation package to ensure improved referrals from schools to SAAJs.
Regina Fernando, Maternal and Child Health (MCH) Nurse assigned to the Micajune Health Center, is satisfied with the current level of acceptance of PrEP by adolescents and young people, which was a real barrier when the service was first introduced at that health facility. “In the beginning, there was a lot of fear on the part of young people who came to seek our services. Whenever we talked about PrEP, they were worried about having to take a medication that resembles the medication for people living with HIV while they were not sick, and of having adverse effects from the medication. But thanks to the awareness made by health providers at the health facilities and Prevention Champions in the communities through lectures, people’s mentality in relation to PrEP is changing, and today they accept it more easily.
Another aspect that has helped a lot in this change of mentality is the dissemination of messages that talk about PrEP through radio stations here in the city of Quelimane and the distribution of leaflets and posters with messages about PrEP, which help people find answers to their main doubts about PrEP in the privacy of their homes.”
Aware of the importance of taking PrEP, Amélia explained that:
“Even after having received information about what PrEP is and who should take it, I was afraid to take the service, as I was afraid that my family and friends would confuse the medication with HIV treatment. But during the conversation with the nurse, she explained to me in more detail about how PrEP works and I analyzed my own situation. My partner works far from home in another district, and I don't know what he's doing when he´s there, which made me very insecure. That's when I made the decision to protect my health and follow the recommendations I received from the nurse and prevention champion to start PrEP.”
In Q1 COP22, to respond to the need to expand PrEP, FGH worked in coordination with the provincial health authorities to support the training of 41 clinical providers and 42 lay counselors from 26 health facilities in the districts of Ile, Mopeia, Morrumbala, Inhassunge, Gurué, Mocubela, Molumbo, and Pebane. Implementation of PrEP services in these 26 HFs followed shortly thereafter. In addition, refresher trainings were conducted at the health posts located in the following prisons: Cadeia Civil Milange, Cadeia Civil Mocuba, and Cadeia Civil Gurué.
Amélia wanted to make a recommendation for other adolescents and young people, based on her own experience with PrEP: “I've been taking PrEP for about 3 months now and I'm living my life with more confidence because I know I'm in control of my health and I'm protected from HIV. For other young people who are in a situation like mine, I would like to encourage them to go to the nearest health facility to find out about their health status regarding HIV, and if they are eligible, to start PrEP. Also remember that taking PrEP does not mean that we should stop using condoms, because they protect us from other sexually transmitted diseases and unwanted pregnancies.”