ECOM’s Study on PrEP Accessiblity in EECA includes a review of the situation at the end of 2018, including information on existing PrEP programs in the region and plans to create new ones, analysis of obstacles and barriers to expanding PrEP programs, and recommendations for eliminating these barriers.
During the assessment of the availability of pre-exposure HIV prophylaxis (PrEP), the situation in 17 countries of Eastern Europe and Central Asia (EECA) was analyzed: Azerbaijan, Albania, Armenia, Belarus, Bulgaria, Hungary, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Macedonia, Moldova, Russia, Slovakia, Uzbekistan, Ukraine and Estonia.
The assessment showed a low level of availability of PrEP in the EECA region.
At the same time, Truvada and the corresponding generic drugs are registered in all countries considered in the study. However, the clinical protocols required to use these drugs for DCT are developed only in Georgia, Ukraine, and Moldova.
A brief outline of the provision of PrEP is included in the recommendations on HIV prevention and treatment of the Ministry of Health of Armenia. PrEP is included in the National HIV Strategies in three countries: Georgia, Moldova and Armenia.
Only in two out of 17 countries – in Georgia and Ukraine – pilot projects have been developed and are being implemented to adapt PrEP to national health systems. Each project annually offers 100 DCT courses for MSM and trans people. Moldova (as of September 2018) has just begun to implement a pilot project on PrEP, within which priority attention will be paid to discordant couples. In addition, three more countries (Kazakhstan, Russia, and Kyrgyzstan) announced that they plan to begin implementing PSC programs in a pilot format in 2019.
The remaining 11 countries considered in the study expressed their common interest in PrEP, but at the time of the study they had not yet developed clear plans for the implementation of this work and had not identified funding sources.
The main obstacles to the implementation and implementation of PrEP programs are the lack of demand for PrEP for MSM and other key populations because of the low level of awareness and experience in this area. Comprehensive information about PrEP, its effectiveness and necessity should be accessible and reach all target audiences, including key populations, medical workers, other HIV service providers and, of course, decision makers. Another important obstacle to the implementation of PrEP is the significant disconnect between potential clients and key “access controllers” in the form of medical workers and public health officials.
“The existing experience of pilot projects says that PrEP programs should be more focused on client’s needs. This means that PrEP should be accessible not only through medical facilities, but also through community organizations. Close interaction between state and public organizations is crucial. This cooperation should go beyond the framework of mutual customer redirection and develop real joint work with the creation of sustainable mechanisms of national (private and state) support and financing for NGOs and community-based advocacy groups,” – said Gennady Roshchupkin, ECOM’s Community Health Systems Coordinator.