ePrEP: First of its kind, AI facilitated prevention program in South Africa reaches initial 100 clients
For many, the threat of contracting HIV is a very real concern. Fortunately, with access to preventative medications such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), individuals can protect themselves and others while living their lives to the fullest. However, it isn’t enough to just provide general access to prevention options. For many to engage and continue on a prevention pathway, the journey needs to be simple AND convenient.¹ For some, frequent trips to a clinic can pose logistical and financial challenges to staying engaged. Especially if clients feel stigmatized at clinics in their area.²
Enter ePrEP – a client-centered approach to HIV prevention available in South Africa, which provides a faster, easier way for individuals to access PrEP, provided by our team at Audere, along with sexual health service provider Aurum POP INN, Centers of Excellence clinics, and telehealth/ePharmacy provider CareWorks. The program enables PrEP meds to be delivered to the individual’s door through regular AI-facilitated HIV self-testing. Clients are assisted by a customized mobile app which guides HIV test administration and test result photo capture, while CareWorks telehealth counselors trained in HIV prevention are equipped with HealthPulse AI-powered test result interpretations. Counselors review HIV test images alongside results interpreted both by the client and AI to prescribe PrEP or support clients in engaging in HIV treatment services such as ART. Such a workflow with multiple checkpoints enhances client safety while keeping the counselor in the driver’s seat to best manage client care.
Example HealthPulse AI-powered app images:
In South Africa, the ePrEP program is already making an impact; with over 100 individuals registered for the program to date. These individuals are taking control of their sexual health by accessing HIV prevention services at a time and location convenient for them. Saving time, money, and hassle involved in recurring clinic visits while receiving private and confidential health care services. For those living in locations where no clinics are easily accessible, or for those who move or travel, remote access to services can be the determining factor retaining them on PrEP.
South Africa is ripe for novel approaches such as ePrEP, as they are reported to have the highest overall HIV infection prevalence compared to other countries, with 8.45 million South Africans currently known to be HIV positive, an estimated 13.9% of the population.³ As of 2022, in South Africa 94% of people living with HIV know their status, 75% of those are on antiretroviral treatment, and 69% of those on treatment are virally suppressed.⁴ In order to reach the United Nations HIV/AIDS 95-95-95 targets by 2030, South Africa still has a long way to go, but with differentiated care models like this, these goals are within reach.
It is well studied that when taken as prescribed, PrEP is highly effective at minimizing the risk of acquiring HIV.⁵ However, among the general South African population, lack of PrEP knowledge and access to PrEP are prominent factors impacting PrEP use. These barriers are heightened among key populations, who can be refused access to health services based on their gender identity or behaviors.⁶ ⁷ In a survey of nearly 400 facility staff who work in facilities where PrEP is available, only 28% indicated PrEP was offered to transgender people.⁶ This persistent stigmatization could be addressed through scale-up of ePrEP programs across community-based, private, and public sectors to address many of the goals and objectives in South Africa’s National Strategic Plan, including, “strengthening community-led responses to HIV,” “reducing stigma and discrimination to advance rights and access to services,” “reducing new HIV infections by optimizing the implementation of high-impact HIV-prevention interventions” and “harnessing technology and innovation to fight the epidemics with the latest available tools.”⁸ Maximizing equitable and equal access to HIV services and solutions for all, and making it easier for hidden populations to engage, can move the needle.
If you're interested in piloting a program in your community, please contact Audere. The initial catalytic investment in the technology was generously covered by the Bill and Melinda Gates Foundation, making this intervention an affordable option to integrate into existing systems or deploy as an end-end solution to accelerate achieving the UN’s 95-95-95 targets.
The ePrEP program is currently available to individuals in South Africa who identify as gay, bisexual, queer, men who have sex with men (MSM), and transgender people. Those interested can register for the program via phone, WhatsApp, or Please Call Me at (079) 035 5861.
We're honored to help facilitate PrEP home delivery facilitated by AI and telehealth for differentiated care access and are inspired by the clients engaging in the program. Our goal is to ensure everyone, everywhere can stay safe by being PrEPared!
About POP Inn Clinics
The Aurum Institute POP INN clinics were launched by Aurum in October 2019 to offer specialized and free sexual health services to MSM and TGW clients in five South African districts. The POP INN centers in these regions provide a safe space for key populations to receive tailored services, such as the screening of TB, STIs, and HIV, receive ART and PrEP medications, as well as psychosocial services. Aurum has partnered with CareWorks in South Africa to provide an ePharmacy solution to their MSM and TGW PrEP clients. The ePharmacy model is mitigating challenges related to dispensing, distribution, and collection of medicines by using online services to create demand, in combination with a call center and a courier system to provide support and dispense PrEP medication while ensuring that clients obtain a confirmatory HIV negative test every three months before receiving PrEP refills.
About CareWorks
CareWorks was founded in 2003 and provides healthcare services that include but are not limited to comprehensive chronic disease and disability management, onsite health risk assessments and screening, COVID-19 screening and support, as well as training and education programs. CareWorks runs HIV programs for general, priority, and key populations with services including HIV Testing Services (HTS), client management, and treatment. CareWorks has proven capabilities and success in key population-led peer mobilization and delivery of health services for MSM and Female Sex Workers. As a result, the organization’s prevention interventions are specifically designed to promote behavior change and risk mitigation, including PrEP and voluntary medical male circumcision (VMMC), as well as other complementary services. CareWorks’ virtual ePharmacy, a client and care centered, technologically advanced, evidence-based intervention, focused on achieving high levels of treatment initiation as well as retention in care, is used to support ART, PrEP and HIVST for hard-to-reach and key population clients. CareWorks’ programs increase access to services, provide continuity of care, and reduce new infections in high-risk populations. The evidence-based, data, and technology-driven interventions at CareWorks have a high success rate across all 95-95-95 program areas, delivering excellent results with over 45,000 HIVST kits distributed to date through online ordering platforms, supported by ePharmacy.
¹Muhumuza R, Ssemata AS, Kakande A, et al. Exploring Perceived Barriers and Facilitators of PrEP Uptake among Young People in Uganda, Zimbabwe, and South Africa. Arch Sex Behav. 2021;50(4):1729-1742. doi:10.1007/s10508-020-01880-y
²Lane T, Mogale T, Struthers H, McIntyre J, Kegeles SM. "They see you as a different thing": the experiences of men who have sex with men with healthcare workers in South African township communities. Sex Transm Infect. 2008;84(6):430-433. doi:10.1136/sti.2008.031567
³Statistics South Africa, 2023. Available at: https://www.statssa.gov.za/publications/P0302/P03022022.pdf
⁴WHO HIV Country Intelligence. South Africa HIV Country Profile for 2022 available at: https://cfs.hivci.org/index.html
⁵Kecojevic, A., Meleo-Erwin, Z. C., Basch, C. H., & Hammouda, M. (2021). A thematic analysis of pre-exposure prophylaxis (PrEP) YouTube videos. Journal of Homosexuality, 68(11), 1877-1898.
⁶Pillay, D., Stankevitz, K., Lanham, M., Ridgeway, K., Murire, M., Briedenhann, E., Jenkins, S., Subedar, H., Hoke, T., & Mullick, S. (2020). Factors influencing uptake, continuation, and discontinuation of oral PrEP among participants at sex worker and MSM facilities in South Africa. PloS One, 15(4), e0228620.
⁷Ritshidze State of Healthcare for Key Populations, February 2023, 2nd Edition. Available at: https://ritshidze.org.za/wp-content/uploads/2023/03/Ritshidze-State-of-Healthcare-for-Key-Populations-2023.pdf
⁸The National Strategic Plan for HIV, TB, and STIs 2023-2028. The South African National AIDS Council.