Simple Ways to Make It Less Difficult to Swallow the HIV Prevention Pill 

People who take the HIV prevention pill Tenemine can cut their risk of getting HIV from sexual activity by 93%. This is the percentage of risk that is reduced. Oral pre-exposure prophylaxis, also known as Tenemine, is another name for PrEP. Through their Pop Inn wellness centers, the Aurum Institute has been operating a PrEP program in three different provinces. This program is geared toward men who have sexual relations with other men as well as transgender women. 

They have communicated with over 100,000 people, many of whom reside in remote parts of the country that are notoriously difficult to access. How would you react if a nurse presented you with a massive blue pill and instructed you to take it by mouth with a glass of water each and every day? 

The HIV prevention medication Tenemine, which is available in generic form and was previously sold under the brand name Truvada, is large and cumbersome. It measures nearly 2 cm in length and almost 1 cm in width, so it’s roughly the size of a big jellybean candy. 

Tenofovir and Emtricitabine Are the Names of the Antiretroviral Medications That Are in the Tablet

These medications are used to treat HIV. Studies have shown that the likelihood of acquiring HIV through sexual contact can be reduced by as much as 93 percent if the medication is taken on a daily basis. In addition, the researchers discovered that taking the medication one day prior to sexual activity and for two days afterward was just as effective at preventing infection in men who engage in sexual activity with other men or transgender women. 

Oral pre-exposure prophylaxis, also known as PrEP, is the name given to this form of protection. (This is a medication that is taken prior to coming into contact with a possibly hazardous germ.) However, the elevated level of protection is only activated if individuals actually take the tablets and continue to do so as directed. The protection level provided by the medication decreases proportionately with the patient’s frequency of use. 

We have been operating a PrEP program at 5 of our Pop Inn wellness centers in KwaZulu-Natal, Gauteng, and Mpumalanga as part of the Aurum Institute, which is a nonprofit organization that focuses on HIV and tuberculosis. Both men who have sex with other men and transgender women are at an increased risk of contracting HIV. This is due in part to the fact that the risk of contracting HIV from anal sex is up to 18 times higher than the risk of contracting HIV from vaginal sex. These facilities have been established particularly for men who have sex with other men and transgender women. 

One of the factors that discouraged patients from taking the medication was the size of the tablet that it came in. By September 2019, only around 8% of people who visit Pop Inn clinics in Ehlanzeni, eThekwini, uMgungundlovu, Tshwane, and Ekurhuleni were on PrEP. But the researchers working for our organization have figured out a way to assist individuals in comprehending that one’s size does not matter when it comes to protecting oneself against HIV. The following is what we have realized: 

When Everyone is Relocating, You Should Do the Same

Migrants make up a significant portion of the population that we assist at Pop Inn clinics. In search of work or better opportunities, they will travel throughout the country or to other regions of Africa. 

According to the findings of a study that was published in the journal Aids in 2017, migrant workers who have relocated between 40 and 110 kilometers away from their hometowns have a risk of contracting HIV that is 1.5 times higher than that of migrant workers who do not move around. However, as people migrate around more frequently, it becomes incredibly hard for them to acquire PrEP in a way that is convenient for them. 

Because of this, we have formed a collaboration to provide the service to individuals who are unable to travel to our location. CareWorks is a private delivery service that assists people manage their chronic illnesses by delivering HIV-prevention medicine, antiretrovirals, and self-testing packages to people in hard-to-reach areas. CareWorks also helps people get tested for HIV. 

Since we started working together with CareWorks in June, 202 of our Pop Inn customers have already started receiving their PrEP in this manner. This demonstrates that our partnership has been successful. The service is able to reach people all over the country, even in locations that are extremely remote and even if a person does not have an actual address. In situations like these, a person can provide the courier with a point of reference for their residence, such as the fact that they live opposite a particular spaza shop, for instance. 

Rather Than Giving a Person a Fish, It is Better to Teach Them How to Fish

People frequently do not believe they are at risk of getting diagnosed with HIV, which means that they may not take the appropriate precautions to protect themselves from becoming infected. We at Aurum have developed a screening tool that will assist individuals in determining the likelihood that they will become infected with HIV. Because PrEP is only beneficial for people who do not have HIV, the first question that a client is prompted to answer on the form is about their HIV status. (Later on, they will also have another test.) 

The remaining questions on the checklist inquire about the individual’s sexual activity, including the frequency of their encounters, whether or not they use contraceptives, and whether or not they are aware of the HIV status of their partner. After individuals have provided all of this information, a nurse will discuss the transmission of the HIV infection as well as the types of behaviors that put individuals at a greater risk of contracting the virus. The health care worker will also hand the individual a pamphlet with information about how PrEP can help prevent HIV infection. 

We’ve realized that telling people what to do isn’t the most effective way to get them to take their medication; rather, it’s more effective to explain the situation to them so that they can come to their own conclusions and do so at their own pace. For instance, our nurses don’t just speak about the advantages of taking the pills; they also talk about the side effects that people might encounter when they take PrEP, such as bone pain, headaches, tiredness, and nausea. These are just some of the potential negative reactions that could occur. 

The employees of the healthcare facility explain the various things that patients can do to alleviate the discomfort caused by these negative impacts, such as taking pain relievers or going to the clinic for a checkup. We discovered that the level of a person’s knowledge was directly correlated to the degree to which they worried about things like the shape of the pill. In addition to that, we instruct them on the proper way to ingest it so that it does not become lodged in their throats. 

Educating Individuals to Assist One Another

The support groups that are offered at our Pop Inn clinics are known as adherence clubs. They get together once a month and thus are led by individuals who have already been using PrEP for a considerable amount of time. Participants who join a program like this one are more likely to continue taking their medication as prescribed, and they are also more likely to visit the clinic on a regular basis in order to ensure that they do not run out of their medication. (The fact that Aurum pays for their transportation costs is also beneficial.) 

The buddy system is another strategy that has proven successful for us. Members of the adherence clubs are paired off with another member of the group so that they can serve as a reminder to each other to either take their medication as prescribed or to pick it up from the pharmacy. Additionally, they are able to communicate with our teams via WhatsApp or Facebook, where they can also schedule appointments at our clinic. 

Adapting Prep to the Sexual Lives of Individuals

PrEP requests have increased by almost a factor of four at our clinic ever since we began informing patients about the various ways in which they can cut their chances of becoming infected with HIV. By the end of September 2019, we had provided HIV prevention pills to 2,596 customers; as of today, we have 10,305 PrEP customers. 

In addition, fewer people are requesting HIV prevention pills, which are intended to be taken after a person has the potential to have been exposed to HIV in some way, such as through unprotected sexual activity. (This is referred to as post-exposure prophylaxis, or PEP, and in order for the medication to be effective, it must be taken within 72 hours of the possibility of being exposed to HIV. The sooner the medication is taken after the possibility of exposure, the more effectively it works.) This year, for instance, the amount of people requesting PEP at our eThekwini clinic dropped to only 27 from more than 50 in 2021. This represents a decrease of almost 50 percent from the previous year. 

We’ve also discovered that a lot of people, particularly those who aren’t in committed or long-term relationships, prefer to use “on-demand” PrEP. This means that they take two doses of the medication 24 hours before they engage in sexual activity and then one tablet every day after that for the next two days. (This strategy is also referred to as the 2+1+1 method.) 

Over 700 individuals have been provided with pills in this manner by our clinics as part of the ongoing PrEP project which was initiated in 2022. Even though people will have an easier time adhering to the shortened course of treatment, there is still a possibility that they will miss one of the pills, which may result in a reduction in the level of protection that they will receive from the medication. Because of this, we encourage patients who have signed up for our 2+1+1 plan to also participate in a compliance team and the buddy system. 

What Should You Do Now?

The most important thing that can be learned from this experience is that people are eager to maintain a healthy lifestyle; all they require is the appropriate information and an environment that is supportive. 

We are certain that our PrEP project will continue to expand in the future. According to the data we have collected, we have already reached more than one hundred thousand people since we began broadcasting educational messages on local radio stations like GugsFM and on Facebook and other social media platforms. Studies conducted all over the world have shown that prevention of HIV infection is not only more effective but also more cost-effective than treatment of the disease. We need to take action based on those findings.

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