Scaling up for impact: HIV testing counselor-led pathway to accelerate PrEP delivery at scale

ABSTRACT We have entered an exciting era for PrEP with two additional non-oral products, a monthly dapivirine vaginal ring and a bi-monthly injectable cabotegravir, with several more options in various stages of clinical development. While the effectiveness of these interventions is now well established, uptake and persistence on PrEP depend

not only on client-level factors but also on how well opportunity costs and health system barriers can be navigated by potential PrEP clients. Thus, taking these novel PrEP interventions to full scale will require simplifying and diversifying models for delivery, to achieve options that are accessible, scalable, and meet the needs of clients

and health systems. Since 2020, in collaboration with the Kenyan Ministry of Health we have demonstrated PrEP can be delivered in African family planning clinics (FP) using existing staff and infrastructure in a programmatic stepped-wedge cluster-randomized trial (FP-Plus project), significantly increasing the proportion of general

population women screened for PrEP from 3% to 93% and PrEP initiations among eligible women from