HIV Pre-Exposure Prophylaxis Scale-Up in Mozambique from October 2021 to December 2023

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Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search HIV Pre-Exposure Prophylaxis Scale-Up in Mozambique from October 2021 to December 2023 Gonçalves Maibaze , Nuno Gaspar , Jessica Seleme , Meghan Swor , Aleny Couto , Inacio Malimane , Marcos Canda , Ana Paula Simbine , Mark Troger , Evangelina Namburete doi: https://doi.org/10.1101/2024.11.25.24317762 Gonçalves Maibaze 1 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention (CDC) , Maputo, Mozambique MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: rne8{at}cdc.gov Nuno Gaspar 2 U.S. Agency for International Development (USAID) , Maputo, Mozambique MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jessica Seleme 3 Ministério da Saúde , (MISAU), Maputo, Mozambique MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Meghan Swor 2 U.S. Agency for International Development (USAID) , Maputo, Mozambique MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Aleny Couto 3 Ministério da Saúde , (MISAU), Maputo, Mozambique MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Inacio Malimane 1 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention (CDC) , Maputo, Mozambique MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Marcos Canda 1 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention (CDC) , Maputo, Mozambique MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ana Paula Simbine 2 U.S. Agency for International Development (USAID) , Maputo, Mozambique MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mark Troger 4 U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) , Maputo, Mozambique MS, MSF Find this author on Google Scholar Find this author on PubMed Search for this author on this site Evangelina Namburete 4 U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) , Maputo, Mozambique MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Summary In 2021, The Mozambique Ministry of Health began offering HIV pre-exposure prophylaxis (PrEP) in all provinces. The number of new clients increased more than three-fold within two years. Among 51,848 new people receiving PrEP by December 2023, the largest groups were females and adolescent young adults. Introduction Robust combination prevention strategies are crucial to ending AIDS as a public health threat by 2030. Aiming to minimize the number of new infections, HIV pre-exposure prophylaxis (PrEP) is a core component of combination prevention recommended by the World Health Organization (WHO). 1 - 3 PrEP lowers the risk of HIV acquisition among HIV-negative people by using antiretroviral medication. 1 , 2 Several options are available, including daily oral and injectable long-acting PrEP. In general, WHO recommends that healthcare providers prescribe PrEP to individuals who could benefit from PrEP, for example: a) Individuals who request PrEP; OR b) Individuals with likely ongoing HIV exposure, which may include any of the following: i. a sexual partner living with HIV who is not virally suppressed on HIV treatment; ii. recent or probable future inconsistent use of condoms for vaginal or anal sex; iii. a recent sexually transmitted infection (STI); iv. recent PEP use for sexual exposure to HIV, especially for individuals who have used PEP more than once. 2 In 2017, Mozambique piloted PrEP programming in three provinces (Nampula, Zambezia, and Sofala), initially prioritizing key populations (KPs), serodiscordant couples, adolescent girls, and young women (AGYW), and pregnant and breastfeeding women (PBFW). Given high acceptance among people utilizing PrEP, Mozambique scaled up PrEP nationally in 2021 to all at-risk individuals who met eligibility criteria: a person with an HIV-negative test within the last 3 months with no suspicion of acute HIV infection based on screening signs and symptoms, without contraindications to PrEP drugs, and with signed informed consent. 4 To understand progress in scaling–up PrEP in Mozambique, we analyzed program data from 2021 to 2023. Methods We analyzed U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Monitoring, Evaluation, and Reporting quarterly data from October 2021 to December 2023 from all PEPFAR-supported sites in Mozambique. 1 A “new PrEP client” was defined as a person who is HIV-negative and newly enrolled in PrEP services. “Continuity on PrEP” was defined as a PrEP client who returned for a PrEP follow-up visit or re-initiation, excluding people newly enrolled 4 , 5 An “HIV seroconversion” was defined as a PrEP client who tested positive for HIV using the Mozambique national algorithm after ≥3 months of PrEP enrolment. 4 Following Mozambique Ministry of Health PrEP guidelines, high-risk groups were PrEP clients aged 15–24 years and KPs. 4 Data were analyzed by quarter, sex, province, and high-risk groups. Results From October 2021 to December 2023, new PrEP clients increased from 15,733 to 51,848 (females = 9,575 [60.8%] to 33,949 [65.5%]; 15–24 years = 7,321 [46.5%] to 26,786 [51.7%]; KPs = 3,646 [23.2%] to 12,613 [24.3%]). Overall provincial growth rate ranged from Manica Province, with a growth rate of 26% (from 4,053 to 5,115), to Maputo City, with a growth rate of 3,405% (from 95 to 3,330) ( Table 1 ). View this table: View inline View popup Download powerpoint Table 1. Number of New PrEP Clients, by Province of Mozambique, and Percentage Increase between October–December 2021 to October–December 2023 During the October–December 2021 quarter, a total of 4,920 clients returned for PrEP follow-up or a re-initiation visit (females = 3,068 [62.4%]; 15–24 years = 1,974 [40.1%]; KPs = 1,025 [21.0%]). Between October–December 2023, a total of 22,273 clients returned for PrEP follow-up or a re-initiation visit (females = 14,153 [63.5%]; 15–24 years = 10,029 [45.0%]; KPs = 3,639 [16.3%]) ( Table 2 ). View this table: View inline View popup Download powerpoint Table 2. Number of PrEP Clients who returned for continuity or re-initiation of PrEP, by Province of Mozambique, and Percentage Increase between October–December 2021 to October–December 2023 Discussion In 2 years, new PrEP clients increased by 230%, with the largest groups receiving services being females, adolescents, young adults, and KP, who are at high risk for acquiring HIV infection. Continued scale-up could be supported by improved demand creation, community education, patient literacy, and further support for the continuity of PrEP for those in need. While the scale-up has been impressive, the literature supports wider dissemination of PrEP literacy to both providers and clients to increase equitable PrEP uptake among targeted at-risk populations as well as improve the use of PrEP drugs as prescribed. 6 - 8 Our findings support further expansions of our PrEP program to reach more people, including developing a communication package for literacy, which will include a PrEP communication campaign, quality improvement interventions, a demand creation strategy, and an assessment of PrEP acceptability. There are several limitations of the analysis. Analyzed programmatic data quality may be impacted by reporting challenges. However, continual data quality improvement activities minimized challenges. Further, reported data did not capture contextual differences, which could be useful for understanding percentage increases. Finally, clients could seek services at any site, regardless of residence. Thus, some people might have been counted as being on PrEP more than once. Data Availability All data produced are available from PEPFAR Monitoring, Evaluation, and Reporting program data. https://data.pepfar.gov/datasets#PDD Conflict of Interest all authors declare no competing interests Funding Acknowledgement This manuscript has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR), through the Centers for Disease Control and Prevention (CDC), The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the funding agencies. Acknowledgements We would like to extend our gratitude to the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID), and the Ministério da Saúde (MISAU) of Mozambique for their support and collaboration in this manuscript. We are grateful to the healthcare providers, clinicians, and staff who have dedicated their time and effort to the implementation and expansion of the HIV pre-exposure prophylaxis (PrEP) program across Mozambique. Their unwavering commitment has been instrumental in reaching this coverage of PrEP services. Footnotes ↵ 1 This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy. See e.g., 45 C.F.R. part 46.102(I)(2), 21 C.F.R. part 56; 42 U.S.C. 241(d); 5 U.S.C. 552a; 44 U.S.C. 3501 et seq. References 1. ↵ US Centers for Disease Control and Prevention US Public Health Service . Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2021 Update Clinical Practice Guideline . 2021 : 108 . 2. ↵ World Health Organization . WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection: provider module for oral and long-acting PrEP . Geneva : World Health Organization ; 2024 . Licence: CC BY-NC-SA 3.0 IGO. 3. ↵ UNAIDS . Combination HIV Prevention: Tailoring and Coordinating Biomedical, Behavioural and Structural Strategies to Reduce New HIV Infections. Geneva 2010 . 4. ↵ Mozambique . MoHo. HIV Pre-Exposure Prophylaxis Guidelines. Maputo 2020 . 5. ↵ U.S. President’s Emergency Plan for AIDS Relief . Monitoring, Evaluation, and Reporting Indicator Reference Guide: Version 2.7 . 2023 . 6. ↵ Zhai Y , Isadore KM , Parker L , Sandberg J. Responding to the HIV Health Literacy Needs of Clients in Substance Use Treatment: The Role of Universal PrEP Education in HIV Health and Prevention . International Journal of Environmental Research and Public Health 2023 ; 20 : 19 . DOI: 10.3390/ijerph20196893 . OpenUrl CrossRef 7. Young I , Valiotis G. Strategies to support HIV literacy in the roll-out of pre-exposure prophylaxis in Scotland: findings from qualitative research with clinical and community practitioners . BMJ Open 2020 ; 10 ( 4 ). DOI: 10.1136/bmjopen-2019-033849 . OpenUrl Abstract / FREE Full Text 8. ↵ Hillis A , Germain J , Hope V , McVeigh J , Hout MCV . Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming . AIDS and Behavior 2020 ; 24 : 11 . DOI: 10.1007/s10461-020-02855-9 . OpenUrl CrossRef View the discussion thread. Back to top Previous Next Posted November 26, 2024. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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