A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa

Abstract

Background: Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities.

Methods: We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16-25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context.

Results: A total of 585 young women started PrEP at the TTT between July 2017 - October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT's integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery.

Conclusions: PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.

Keywords: Adolescent girls and young women (AGYW); Community mobile health clinic (CMHC); HIV prevention; PrEP delivery models; Pre-exposure prophylaxis (PrEP); Sexual reproductive health services (SRHS).

Fig. 1

a and b The Tutu Teen Truck mobile health clinic is a Mercedes Sprinter clinic conversion with private consultation rooms delivering services to adolescent and young people in densely populated, resource limited areas

Fig. 2

Clinic flow on the TTT mobile clinic include an educational area; four individual consultation rooms for point-of-care HIV and pregnancy testing and health counselling; and a PrEP and contraception dispensing room. Blood and urine samples to verify eligible creatinine clearance and current STI infection (gonorrhoea/chlamydia) are collected by the nurse on the mobile clinic and sent off daily via a courier pick-up service to laboratories for analysis