Background
Pre-exposure prophylaxis (PrEP) is pivotal in HIV prevention. The recent introduction of long-acting injectable PrEP, alongside oral PrEP. The USAID DISCOVER-Health project, implemented by JSI, has layered injectable PrEP onto its existing oral PrEP service delivery platform. This study examines how layering injectable PrEP onto existing oral PrEP services affects initiation and retention at one month, comparing data from periods before and after its implementation.
Methods
Methods: A retrospective cohort analysis was conducted using routine data from four health facilities offering both oral and injectable PrEP in Kitwe and Chibombo district. Data from six months prior to the introduction of injectable PrEP, August 2023 to January 2024 (pre-implementation period) was compared with data from six months post-implementation, February to July 2024 (implementation period) for the same facilities. Average monthly PrEP initiation were calculated to assess changes in access, and retention at one month, measured as the proportion of individuals returning for follow-up after initiation. Independent T-tests were used to statistically compare differences in initiation and retention between the two periods.
Results
Results: During the implementation period, 2,752 individuals started PrEP (oral 1,639 and injectable 1,113), with a one-month retention rate of 86.0% (oral 81% and injectable 96%). In contrast, during the pre-implementation period, 2,191 individuals started oral PrEP, with a one-month retention rate of 65.4%. During the implementation period, monthly PrEP initiations (mean=458.7, SD=448.6) were higher compared to the pre-implementation period (mean=365.2, SD=161.1), though this difference was not statistically significant (t=0.48, p=0.64). Retention at one month was also higher in the implementation period (mean=0.818, SD=0.078) than in the pre-implementation period (mean=0.691, SD=0.182), the difference was statistically significant (t=2.57, p<0.05).
Conclusions
Conclusion: Layering injectable PrEP significantly improved one-month retention rates compared to oral PrEP alone, with retention being highest among those on injectable PrEP. While the number of PrEP initiations increased during the implementation period, this difference was not statistically significant but a very important change in PrEP scale up. These findings suggest that injectable PrEP can enhance adherence and retention, especially in the early stages of use.