Background
Rise of web-based dating platforms have created a “virtual vulnerable population” who do not visit traditional HIV sites, with an HIV burden 20 times higher than the national average (0.2%) highlighting the need to adapt virtual service delivery of interventions such as PrEP . Given the penetration of mobile technology in India with resource limited settings, PrEP delivery via a virtual platform could close this gap.
Methods
Since 2020, the Safe Zindagi (SZ) website has provided comprehensive HIV and sexual health services such as HIV testing (self-testing), PrEP and treatment services through a virtual network of doctors, pharmacies, and counselors by reaching diverse populations across India via social media and dating applications. For PrEP, virtual counselors (VCs) assist clients to book subsidized baseline lab tests and tele-consultation with a doctor on SZ. If eligible, subsidized medications are couriered or picked-up by clients through pre-selected pharmacies. VCs, doctors, and automated messages support adherence and retention via tele-counseling, periodic HIV testing and refill reminders. We describe the PrEP uptake and retention over a 4-year period
Results
3486 clients across 90 Indian districts (June 2020-August 2024) were interested in PrEP, of whom 3329 were eligible and 3063 (92%) initiated PrEP. Median age at initiation was 26 years; 59% were cisgender men, 18% ciswomen, and 23% transgender persons. Of the 3063 clients who initiated PrEP, 39% were still on PrEP as of August 31, 2024. The median time on PrEP per client was 156 days; 71% of clients were retained at least for 12 months. Over 4 year period, retention was higher in cisgender men and women compared to TG and was lowest (35%) in clients aged 15-29 years and highest (58%) in 40-55 year old clients. Among clients that discontinued PrEP, 18% were sero-discordant couples, 43% reported reduced HIV risk (e.g. change in sexual behaviors) and other issues like affordability, migration, and lost to follow up.There have been 3 documented sero-conversions among PrEP clients – all clients had a PrEP interruption prior to seroconversion.
Conclusions
Data highlight the feasibility of a web-based platform in delivering PrEP services virtually to vulnerable virtual populations in low- and middle- income settings with retention comparable to other physical PrEP programs. Such a platform lends itself to expansion for other services (e.g., PEP, DoxyPEP, etc.) to ensure individually tailored services at scale.
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