WhatsApp and Zoom

TuConnect TuPrEP Final Zoom Meeting Report

Date: Thursday, September 25, 2025
Time: 3:00 PM - 4:30 PM EAT
Topic: Overcoming PrEP Implementation Barriers: Multi-Level Challenges and Solutions
Meeting Duration: 76 minutes
Format: Member-Led Discussion

Primary Presentation: Four-Level Barrier Framework

1. Client-Level Barriers

Key Barriers Identified:

• Fear of PrEP safety during pregnancy and breastfeeding

• Stigma and shame about being perceived as "at risk"

• Low risk perception ("it won't happen to me" mentality)

• Partner objections and intimate partner violence concerns

• Daily pill burden and adherence challenges

Case Examples Shared:

• Client experiencing headaches as side effect, resolved through counseling about temporary nature

• Teenage mother avoiding PrEP due to fear of partner violence if discovered

• Client refusing PrEP believing they were ARVs for HIV treatment

• Student questioning need for protection when having sex with HIV-positive partners

• Female client reporting loss of sexual desire while using PrEP (resolved through counseling)

Solutions Implemented:

• Peer mother programs to share positive experiences across different populations (youth, married individuals, sex workers)

• Focus messaging on protection rather than risk

• Discrete pill storage options to address stigma

• Flexible appointment scheduling, especially for school-going youth

• Targeted school outreach programs with comprehensive education
  
  
  
  

2. Provider-Level Barriers

Key Barriers Identified:

• Limited PrEP knowledge among clinical staff

• Discomfort discussing sexual behavior, particularly with adolescents

• Time constraints for comprehensive counseling

• Uncertainty about eligibility criteria

• Bias toward certain client populations

• Administrative delays and insurance coverage issues

• Geographic distance challenges for client access

Challenges Highlighted:

• Casual pharmacy workers lacking PrEP training when regular staff unavailable

• Clients without ID cards being turned away at registration

• Single providers managing multiple services simultaneously

• Knowledge gaps among different staff cadres

Solutions Proposed:

• Regular Continuing Medical Education (CME) sessions about PrEP

• Training all staff levels, not just specialists

• Use of job aids and standardized checklists

• Practice counseling scenarios among staff

• Longer appointment intervals for clients traveling long distances

• Facility-level discussions to address ID card requirements for PrEP services
  
  
  

3. Health System Barriers

Key Barriers Identified:

• PrEP services limited to HIV clinics only

• Frequent medication stock-outs

• Complex documentation requirements

• Long waiting times

• Poor pharmacy storage conditions

• Theft of PrEP medications from facilities

• Lack of privacy in medication dispensing areas

Storage and Security Issues:

• Improper drug storage affecting medication quality

• Facility infrastructure problems (leaking roofs, inadequate storage)

• Unauthorized access to PrEP medications

Solutions Implemented:

• Service integration across multiple departments (MCH, Family Planning, OPD, Maternity)

• Development of stock management systems with departmental distribution

• Training pharmacy staff on PrEP identification and dispensing

• Creation of PrEP-specific appointment slots

• Implementation of lock-and-key storage systems

• Private spaces for medication dispensing to ensure confidentiality
  
  
  
  

4. Community-Level Barriers

Key Barriers Identified:

• Myths about PrEP causing HIV infection

• Beliefs that PrEP users are promiscuous

• Male partner resistance to female PrEP use

• Limited community awareness about PrEP

• Cultural and religious objections to prevention methods

Community Engagement Strategies:

• Engagement with community leaders and elders

• Chief baraza (community meeting) presentations

• Partnership with men's groups, women's groups, and boda-boda (motorcycle taxi) associations

• Use of Community Health Promoters for education during home visits

• Distribution of IEC materials and flyers

• Direct addressing of myths during health talks

• Creation of specific networks for different populations (schools, fishermen, gold miners)

Study Conclusion and Platform Continuation

Pilot Study End: October 17, 2025

Platform Accessibility Post-Study:

• WhatsApp group remains active for ongoing discussions

• Website resources continue to be available

• New healthcare workers can be invited to join platforms

• Zoom meetings can still be organized as needed

• Training materials and guidelines accessible online

Final Activities:

• Last quarterly survey to be distributed within one week

• Reimbursement provided upon survey completion

• Open invitation for facility colleagues to join ongoing discussions

Supply Chain Updates

Ongoing Challenges:

• Current stock-outs reported at some facilities

• Expiring medications requiring urgent replacement

• Need for creatinine testing availability for PrEP monitoring

Action Items and Commitments

Healthcare Provider Actions:

• Conduct facility-based CME sessions on PrEP

• Train pharmacy staff including casual workers

• Integrate PrEP services across departments

• Develop facility-specific stock management systems

• Simplify record-keeping processes

• Engage peer mothers and community leaders

• Partner with community groups for awareness

• Provide discrete storage solutions for clients

• Offer flexible scheduling for vulnerable populations

CoP Manager Actions:

• Distribute final quarterly survey

• Process participant reimbursements

• Maintain platform accessibility

• Continue resource availability