Logistics

Please mute your line when not speaking

Introduce yourself by writing your name, affiliation and country in the chat box - Head to the RLC Mighty Networks to tell us about your organization.

Please enter all questions in the chat box

For any technical difficulties, please send a message to cbishopp@fhi360.org

A recording of this session will be shared with all participants

We will launch a survey about your experience with the RLC at the end of the call – please stay with us to complete the survey here, or follow email instructions after the call to access the survey online

For phone lines, press *6 to mute

PROMISE/CHOICE Ring Learning Collaborative

02 SEPTEMBER 2021

PROMISE/CHOICE

Ring Learning Collaborative

SESSION 3

Regional Collaborative – Session 3

Hosted by PROMISE/CHOICE and the NATIONAL AIDS & STI CONTROL PROGRAMME

(NASCOP) Kenya

Today’s Agenda:Timing Topic Moderator

20 min Welcome, Objectives, and Introductions Mary Mugambi, NASCOP Kenya

Patriciah Jeckonia, LVCT Health

15 min Lesson learned from Oral PrEP Brian Pedersen, FHI 360

20 min Panel Discussion Lilian Tutegyereize, FHI 360

5 min PROMISE/CHOICE Demand Creation Tool

Rapid Round-Up

Lilian Tutegyereize, FHI 360

20 min Busara findings Diantha Pillay, IPM

Dennis Kembero and Prithika Mohan, Busara

10 min Q & A and discussion Ruth Kamau, NASCOP Kenya

25 min National Updates Kenya

South Africa

Zambia

Zimbabwe

5 min Upcoming Calls/ Closing Allison Cole, FHI 360

Ruth Kamau, NASCOP Kenya

RLC Objectives:

• Strengthen ability to educate and advocate for the ring

• Support communication and collaboration on ring rollout

• Support integration of the ring into existing HIV

prevention method platforms

• Provide a venue for sharing and co-creation of tools,

resources, successes, challenges, and solutions

Our objective today is to discuss lessons learned

from oral PrEP rollout to ensure that demand

creation for the PrEP ring takes these lessons into

account, and that we prepare end-users to initiate

and use the ring effectively.

Introductions

Please add your name and affiliation in the chat.

Visit the RLC Mighty Networks to tell us about yourself and your organization.

Demand creation lessons learned

from ring clinical trials and oral

PrEP programs in Kenya, South

Africa, Uganda, and Zimbabwe

Document the lessons of dapivirine

vaginal ring (“the ring”) clinical trials and

oral pre-exposure prophylaxis (PrEP)

programs to identify promising strategies

and approaches to create consumer

demand for the ring and other

PrEP products.

Purpose

Methods

• Discussions with ring researchers engaged in clinical trials

in Kenya, South Africa, Uganda, and Zimbabwe and

representatives from key oral PrEP programs in Kenya,

South Africa, and Zimbabwe.

• Semi-structured discussion guides used to explore lessons

learned from clinical trials and oral PrEP rollout and

opportunities for ring demand creation.

• Discussions took place from October 2020 – February 2021

over conference calls lasting approximately 1 hour.

Summary of Lessons Learned

Make PrEP promotion fun

Fun makes audiences, especially young audiences, more receptive to discussing sensitive topics and, most importantly, keeps them engaged. CeSHHAR’s Sisters with a Voice peer education model

Women have lots of questions, staff need to be available to answer questions and demystify the ring, which helps women overcome personal barriers to its use.

Keep it local

Kenya’s Jilinde tries to normalize PrEP use

Normalize use

The ring should be offered to all women in the community to avoid creating stigma.

Audiences respond better to demand creation efforts that position oral PrEP as something more than an HIV prevention product.

Make PrEP about more than HIV

Self-care and empowerment through “V”

Build skills and confidence

Ring researchers found that many women view insertion as an initial barrier to ring use, especially since inserting something into the vagina is new for many women.

The ASPIRE and HOPE studies used an illustrated leaflet

Social media offers an opportunity to reach audiences that prefer anonymity. It also helps to maintain connection to audiences between in-person events and provides reinforcement of key messages and information.

South Africa’s MyPrEP campaign

Use social media to reinforce

Ring researchers found that simple analogies and illustrations were the best way to help women understand ring efficacy. Understanding efficacy is important to ensure informed choice.

Use simple analogies to inform choice

Amplify the experiences of current users

Peers with personal experience were the best recruiters and are best placed to push back on harmful myths and misconceptions, especially about side effects and fertility, before they took root. The HIV Prevention Ambassador

Training Package and Toolkit

Equip PrEP users, especially young people, to confront potential stigma they may face when others find out about their PrEP use.

Equip users to confront potential stigma

“De-individualize” HIV risk

Potential PrEP users worry

about being associated with

the typical “risk behaviors”

for HIV acquisition so use

caution when discussing

PrEP use in the context of

HIV risk.

Engage with media early so that they have the right information about PrEP and can respond quickly to any myths or misconceptions shared through the media.

The PrEP Communications Accelerator module on journalist stakeholders

Engage journalists early and often

The USAID DISCOVER-Health Project video for providers

Get providers on board

Addressing the skills and attitude gaps of providers is one of the best ways to ensure access to PrEP services.

.The key to creating demand for the ring might be to…

• Make ring promotion fun

• Keep it local

• Normalize use

• Build skills and confidence

• Use social media to reinforce

• Use simple analogies to inform choice

• Amplify the experiences of current users

• Make the ring about more than HIV

• Equip users to confrontpotential stigma

• De-individualize HIV risk

• Engage media early and often

• Get providers on board

Thank You!

For more information, please visit:

• https://www.ipmglobal.org/our-work/our-products/dapivirine-ring

• https://www.prepwatch.org/about-prep/dapivirine-ring/

This document is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the terms of cooperative agreements 7200AA19CA00002, 7200AA19CA00003, and AID-OAA-A-15-00045. The contents are the responsibility of the EpiC project, the RISE project, and Envision FP and do not necessarily reflect the views of USAID, PEPFAR, or the U.S. Government.

Panel Discussion

Panelists Position, Organization

Velisiwe “Veli” Kawe HIV Prevention Ambassador, South Africa

Brian Nachipo Advocacy and Communications Officer, Zimbabwe Ministry of Health and Child Care

Ernest Kakoma Senior Health Promotion Officer, Zambia National AIDS Council

Sindy Matse National Key Populations and PrEP Coordinator, Eswatini National AIDS Programme

Velisiwe “Veli” KaweHIV Prevention Ambassador, South Africa

Reflecting on the lessons just shared, what do you think will be some of the

biggest challenges we may face in getting women interested in the ring in

South Africa?

Brian NachipoAdvocacy and Communications Officer,

Zimbabwe Ministry of Health and Child Care

What lessons from oral PrEP demand creation are relevant in

Zimbabwe as healthcare providers are trained?

Ernest KakomaSenior Health Promotion Officer,

Zambia National AIDS Council (NAC)

What key lessons from oral PrEP demand creation are you most interested in

building upon or avoiding?

Sindy MatseNational Key Populations and PrEP Coordinator,

Eswatini National AIDS Programme

What key lessons from oral PrEP demand creation are you most interested in

building upon or avoiding?

Velisiwe “Veli” KaweHIV Prevention Ambassador, South Africa

Following on from what the previous speakers said, what hellos can we learn from oral PrEP to assist when we prepare to introduce the ring? Was there anything that any of the speakers

have shared that is very important to consider for promoting the ring to young women?

Anything you would like to add?

Sindy Matse & Ernest Kakoma

What advice do you have for other countries that haven’t yet started to update their policies – how do you

suggest they best leverage the lessons from oral PrEP demand creation?

PROMISE Preparing for Ring Opportunities through Market Introduction Support and Knowledge ExchangeMONTH | 2020

CHOICE Collaboration for HIV Prevention Options to Control the Epidemic

Additional logo to go here

Lilian Tutegyereize

Technical Officer, FHI 360/Uganda

PROMISE/CHOICE Demand Creation Tool Rapid Round-Up

AUGUST | 2021

What’s happening:

• Tool to help advocates and CSOs to develop a messaging framework and implementation plan in support of ring advocacy activities. Includes examples from Kenya, Zambia, and Zimbabwe and easy-to-use template.

• Available on PrEPWatch next week.

Dapivirine Ring Advocacy Messaging Resource Package

What’s happening:

• Updating to accommodate biomedical prevention products coming on the market.

• New content and sessions related to getting to know our bodies, the ring, and choosing an HIV prevention strategy.

• Currently undergoing field testing in Zimbabwe and South Africa –release expected in late 2021.

HIV Prevention Ambassador Training Package for AGYW (2nd edition)

What’s happening:

• Developing a client-facing tool (paper and digital formats) to provide information and support client journey to select the most appropriate combination of HIV prevention methods. Can also be used by HCW to provide optimized counseling and information to clients.

• Currently undergoing field testing in Zimbabwe and South Africa –expected release in late 2021.

HIV Prevention Ambassador User Journey Tool

Paper-based

Digital

38

Video & recording posted on the Mighty Networks site.

Please enter your questions

in the chat.

Q&A

A recording of this session, as well as a resource sheet of key questions and responses, will be available on the Mighty Networks platform. We

look forward to participating in ongoing discussion and emerging questions with all Ring

Learning Collaborative members on Mighty Networks.

National Updates

KenyaSouth AfricaZambiaZimbabwe

Kenya Dapivirine Ring UpdatesMary Mugambi

HIV Prevention Manager - NASCOP

Kenya Dapivirine Ring Updates

• Current Status:

• What is the current status of the ARV guidelines?

• Validation meeting next week

• Get final approval from MOH

• Dissemination of guidelines at national and county level to different stakeholders i

• Is NASCOP creating an implementation plan or something similar?

• Similar to Oral PrEP, the PrEP CoE will develop an implementation framework for DVR will we revise the current framework and add DVR

• What is the status of PrEP-FP integration and how do you plan to incorporate the ring into your integration plans?

• MOH is implementing a plan to integrate PrEP into FP services

• Training is ongoing for providers

• Training of providers will incorporate DVR

Kenya Dapivirine Ring Updates

• Current Status:

• What are your plans for ring rollout?

• Training of providers

• Engaging end users

• PrEP CoE forums to plan

• Inclusion of demand creation plan

• Development of phased out plan for ring roll-out focusing on counties with high new infections among AGYW

• Have there been any challenges?

• Thinking through an implementation plan without assured funding to support roll-out

• Not having the commodity in the country

Kenya Dapivirine Ring Updates• What lessons have you learned from oral PrEP demand creation?

• National campaigns were a good start but needed to be sustained to reach all localities, messaging and formats needed to include low-tech options in local languages and be tailored for local social/cultural context.

• Demand creation efforts must be accompanied by availability of services; PrEP provision outlets were not adequate when oral PrEP was introduced, which limited ability for interested clients to ‘act’ on PrEP uptake.

• Community peer educators and health providers are instrumental in engaging key beneficiary groups who require trustful relationships, discretion and support for uptake and sustained adherence.

• Using success stories from peers and outreach from trusted facilities will help build rapport with key beneficiaries, especially those in marginalized groups. Providers who are PrEP champions will keep the service in the forefront among competing medical priorities.

• To increase uptake and continuation, through integrating HIV prevention services into other health services, for example sexual and reproductive health services such as family planning services

Kenya Dapivirine Ring Updates

• How will you incorporate those lessons learned to create demand creation for the ring?

• Creating advocates among women such as capitalizing on women with ring experience to be product champions and provide testimonials. Engage young women in message and communication materials development.

• Target women in leadership positions to promote the ring for policy development and gain male buy-in. Partner with male champions as well to garner more support from men.

• Focus resources on sustained training of peer educators and providers about ring to demystify the product and deter stigma.

• Campaigns should be tailored to community needs in terms of format (low-tech vs high tech) and addressing socio/cultural norms that vary across Kenya. Such initiatives must also have the resources and vision to be sustained to keep momentum for demand creation.

• Integrate the ring into other SRH services e.g. Family Planning

• Branding the product to not be associated with ARVs or too ‘medical.’ Branding should be ‘cool’ with colorful packaging or a catchy name.

• Create educational materials that explain the basics about the ring in clear, simple terms as well as address common concerns and myths.

Next Steps

• What are the next steps/milestones for ring planning?

• Dissemination of revised ARV guidelines

• Review of PrEP implementation framework to include DVR

• Convening PrEP CoE meetings to discuss Ring roll-out and develop roll-out plan

• Engagement of potential beneficiaries in planning ring roll-out including advocacy

• Conduct donor round tables to secure funding for DVR

• Develop demand creation strategy for the ring

• Availability of the commodity

Next Steps:

• How will you incorporate end-users, advocates and ambassadors in national demand creation?

• Sensitization of advocates, ambassadors and young women representatives on the ring

• Engaging young women on the demand creation sub-committee of the PrEP CoE

• Involvement of young women in pilot testing ring messages and demand creation tools

• Training and engaging young women as ring champions at facility and community level

• Engaging young women in media campaigns including social media and conventional media (TV, Radio and

newspaper)

Hasina Subedar

Technical Coordinator, HIV Prevention, National Department of Health, South Africa

Zambia

Dapivirine

Ring

Updates

Current Status:

Pilot ring implementation studies planned

for 2021-2022; main outcomes will be

feasibility & acceptability

SBC TWG revising PrEP messages with

improved audience segmentation;

anticipate implementation soon.

Community sensitization prior to PrEP

product introduction that is contextually-

appropriate is critical, based on lessons

learned with oral PrEP

Zimbabwe

Dapivirine

Ring

Updates

Zimbabwe is currently in the process of adapting the July WHO consolidated guidelines including the Ring. We expect to launch the guidelines on the WAD

As a country we formed a taskforce comprised of implementing partners, end-users, donors, organizations providing TA to:

Evaluate our PrEP implementation plan (2018-2020) and assess what worked and what did not work

The same taskforce will develop a new implementation plan which will cater for new HIV prevention options on the horizon.

This process has been consultative in nature with findings already informing what questions the country needs addressed in Ring demonstration projects.

Zimbabwe

Dapivirine

Ring

Updates

The country plans to conduct demonstration projects with key questions still being formulated.

Phased out approach is planned to roll out the DVR- VR .

A phased approach will allow the country to learn slowly and improve along the way.

Lessons learned on demand creation with oral PrEP

Initial demand creation was very localized.

Provider training was slow, with some facilities experiencing implementation lags.

With the Ring, the plan is to avoid implementation lags and mobilize resources for better product availability in more facilities with more geographic coverage.

Zimbabwe

Dapivirine

Ring

Updates

Next Steps:

The Ring guidance will be finalized through

a consultative process with partners and

stakeholders using the PrEP TWG as a

channel.

Through the TWG, there is representation of

various sectors including implementing

partners, advocates, civil society, donors,

potential end-users and AGYW.

From the TWG, there are several working

groups working on specific aspects like

demand creation, M&E, quantification,

etc.

Zimbabwe

Dapivirine

Ring

Updates

In conclusion : some might have

seen this :

Welcome to all new members on the RLC Mighty Networks site!

If you are not already on the RLC online platform, click the link in the chat to join now!

Check out some useful resources to help with ring planning and rollout! Find answers to FAQs and share your own!

Can’t wait to see you on the RLC Mighty Networks!

RLC Evaluation SurveyPlease take the next couple minutes to complete the feedback survey.

Ring Learning Collaborative calls will begin again in 2022. Please stay tuned on Mighty Networks for more announcements and engagement!

For more information, please visit:

• https://www.prepwatch.org/about-prep/dapivirine-ring/

• https://www.mtnstopshiv.org

• https://www.ipmglobal.org/our-work/our-products/dapivirine-ring

This document is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the terms of cooperative agreements 7200AA19CA00002, 7200AA19CA00003, and AID-OAA-A-15-00045. The contents are the responsibility of the EpiC project, the RISE project, and Envision FP and do not necessarily reflect the views of USAID, PEPFAR, or the U.S. Government.

Thank You!