We spoke with Danvic Rosadiño, Head of Programs and Innovations at LoveYourself, a community-based organization providing safe spaces to communities and services related to sexual health, including HIV, trans health and mental health, in the Philippines.
Danvic, please can you describe the context in which LoveYourself operates?
We have 13 community centres in major cities in the Philippines. We are experiencing a low-prevalence, high-incidence HIV epidemic. The number of people living with HIV is still less than 1% of the population (115,248 Filipinos diagnosed with HIV as of April 2023), but acquisitions are increasing rapidly among key populations: gay, bisexual, and other men who have sex with men, trans women, people who inject drugs, sex workers, and others. We are diagnosing around 50 people per day. Nearly half of the new acquisitions are in the 15–24-year age group. If we don’t do something differently, the number of people living with HIV in the Philippines is expected to increase to 401,700 by 2030.
What was the gap or challenge that led to the development of e-PrEPPY?
Pre-exposure prophylaxis (PrEP) has reached more than 10,000 individuals in the Philippines since it was introduced in 2017. But with the type of epidemic we are experiencing, we need to reach more people. Differentiated models of offering PrEP are urgently needed. There are challenges to service access, such as ease of attending a health facility. This is especially the case in Metro Manila where traffic is always heavy and with clients who may be working at night and are confronted with external stigma emphasized by the conservative culture, which is highly religious and views sex as taboo.
In a programme called e-PrEPPY, we introduced an all-virtual, community-led PrEP programme for gay, bisexual and other men who have sex with men using a demedicalized approach.
How does your all-virtual PrEP programme work?
Clients who report as HIV negative in the online unassisted HIV self-testing programme of LoveYourself (SelfCare) are asked for their interest in PrEP. A blood-based self-test kit, with instructions, is sent to their address. Clients can choose between delivery to an address or pick up at logistics partners across the Philippines. They do not need to go to a health facility. Once marked HIV non-reactive, a self-assessment tool is sent to the client to determine their sexual behaviour and the presence of the following: acute retroviral syndrome, kidney-related morbidity and micronutrient supplementation. This information is validated by trained community peers and PrEP information and counselling are provided via telemedicine. A client assessed as eligible is sent one month of PrEP, another HIV self-test kit, and a QR code for refill instructions via courier within three days. The client uses the HIV self-test kit and reports the results. Once marked as HIV non-reactive, the client is sent another self-test kit with PrEP bottles relative to the number of their virtual visits. A demedicalized algorithm was developed to guide community-trained peers to provide PrEP. A physician is on call for any urgent referrals.
How do you measure the impact of the programme?
We measured the impact based on the number of people reached by e-PREPPY initiated on PrEP and those who remain on PrEP. Between August 2022 and April 2023, 230 clients were initiated on PrEP of which 100 (43.48%) completed their first monthly visit and with 92 clients reporting daily PrEP use.
At IAS 2023, we shared the evidence that an all-virtual, community-led and demedicalized PrEP approach integrated with unassisted HIV self-testing is possible. It was once an implementation theory placed under the differentiated and simplified PrEP guidelines, but now, this service shows that it works.
What are the main challenges to implementing and scaling up the programme?
Opening the service to other key populations is our next challenge. In terms of demand creation, a marketing approach tailored for members of one key population group may not work for reaching other key population groups. We need to consult with other communities to help us make this work.