PrEP implementation experiences
Dr. Anton Best shared Barbados experience with rolling out their PrEP program. He explained the barriers and challenges in implementation and made recommendations for overcoming those. He emphasised the importance of integrating PrEP within the health care system and discouraged the establishment of stand- alone PrEP programmes. He posited that integration will not require significant additional resources and can be leveraged as a strength in advocating for PrEP with policy makers.
Dr. Nastassia Rambarran shared the PrEP implementation experience from the perspective of the civil society partner, Equals. She spoke about the lead-up to implementation and how the process works within Equals and in partnership with the Ministry of Health and Wellness. She emphasised the importance of collaboration from the earliest planning phases and throughout implementation.
Advocacy for PrEP
Dr. Anton Best emphasized an important factor for Barbados’ advocacy – he did not request or require additional resources to start the PrEP program – rather he used innovative service delivery models and relied on existing budget resources. Mr. Dereck Springer recommended identifying and seeking country champions – for example, First Ladies. He encouraged participants to stay current with knowledge and evidence so as to effectively advocate with policy makers. Ms. Sandra Jones shared the different ways that PAHO can support countries in rolling out their PrEP programs – by advocating at the regional level, assisting in advocating at the national level through the local PAHO representative, supporting in-country training, and putting together a generic policy brief and generic guidelines that can be adapted to each country. Mr. Anderson Langdon, Executive Director, Barbados Family Planning Association spoke about advocacy approaches and the importance of knowing and understanding your role in the advocacy space. He encouraged civil society to know the evidence on PrEP as this is important for them to be taken seriously by governments and policy makers and be counted as an equal voice at the table.
On the afternoon of the first day, participants visited the two sites working together in offering PrEP in Barbados – the Ladymeade Reference Unit and Equals. At each stop, they were given an overview of what occurs at each site and how the two sites work together. They were given a tour of the space and had the opportunity to ask questions to the program managers. Participants shared that they were really impressed with how the two sites worked together and provided a harmonized experience for those seeking PrEP. One participant noted, “The site visit demonstrated the importance of institutions working together – a healthy relationship can get a lot of things done.”
On the second day, five people participated in a fish bowl exercise – two clients on PrEP, Dr. Tiffany Jordan, Physician, LadyMeade Reference Unit, Nurse Charmaine Ray, Nurse, Ladymeade Reference Unit, and Remington Forde, Outreach Worker, Equals. The Knowledge Coordinator, Dr. Shanti Singh- Anthony who explained the Fish Bowl as a KM methodology and facilitated the session. This experience provided a more intimate view into how and why a person decides to get on PrEP and the lessons that have been learned by healthcare providers in navigating clients to PrEP. It allowed participants to make the connection from policy to PrEP delivery at the community and client levels.
Participating country teams were given the opportunity to share their PrEP stories. As part of the visioning board exercise, countries developed their road-map to rolling out PrEP, highlighting and sharing opportunities and challenges to implementing PrEP in their individual countries. Participants then used the visioning board to develop and present a workplan of activities that they will use to continue to or start to implement PrEP on returning to their countries. Limited buy in policy makers and lack of capacity to plan, implement and monitor PrEP programmes were issues affecting most programmes. At the level of the National AIDS Programme and civil society, there was great enthusiasm to advance the current PrEP narrative in countries. Country specific work plans were developed. These will be combined to produce one Regional work plan.