WHO backs community-based distribution of anti-HIV pill
16 April 2020
MANILA, Philippines -- On the third floor of a nondescript building along Shaw Boulevard in Mandaluyong, Philippines, is a community centre that offers comprehensive HIV-related services. This centre is just one of the six in Mega Manila and another one in Cebu by the community-based organization LoveYourself. Each community centre caters to 60 to 100 clients every day.
“We have different programmes, different types of services for each and every aspect of the HIV care cascade,” said LoveYourself Program Manager Danvic Rosadiño. “That includes awareness, testing, prevention initiatives, treatment, care, and support. And we provide all of the services here for free.”
LoveYourself was established in 2012 by six people and has now grown with more locations, 90 full-time staff and 1,200 volunteers. In 2018, 20% of all HIV-positive diagnosis in the Philippines were made through LoveYourself. They also have 5,000 clients enrolled in treatment. LoveYourself is also partnering with 12 other community-based organizations spread across the country to share their lessons learnt and applying it to their context.
When asked about his thoughts on why LoveYourself has been successful in reaching their clients, Danvic explained, “We are the community, so we know how to reach out to the community.”
As a community of volunteers, feedback is important to the organization. "We always listen to the community,” said Danvic.
“We have mechanisms to facilitate feedback of clients confidentially and in a manner that they won’t also be judged. If they have issues with their privacy, then they could email email@example.com. If they need feedback that needs to be reported, it can be reported on our social media sites” he added. “And we will improve our services based on the feedback that we receive.”
The promise of PrEP
Danvic himself has evolved with LoveYourself. He started as a volunteer in the organization back in 2014 and now manages the oral pre-exposure prophylaxis of HIV infection (PrEP) programme called PrEP Pilipinas.
PrEP is a safe and effective pill taken orally to prevent HIV sexual transmission. WHO recommends PrEP to all population groups at substantial risk from HIV infection. It is as an additional prevention choice in a comprehensive package of services that also includes HIV testing, counselling, male and female condoms, lubricants, antiretroviral treatment for partners with HIV infection, voluntary medical male circumcision and harm reduction interventions for people who use drugs.
PrEP is now available in the Philippines through community-based organization LoveYourself. Photo: WHO/F. Tanggol
PrEP was introduced in the Philippines through PrEP Pilipinas, which started as a community-based, peer-driven demonstration project in 2016 in partnership with the Research Institute of Tropical Medicine, WHO and amfAR. The goal of the demonstration project was to deliver, document and evaluate community-based PrEP services to men who have sex with men and transgender women, who received free PrEP medication (emticitrabine/tenofovir disoproxil fumarate).
This project is close to Danvic’s heart as he himself saw the need for the drug.
“I myself, I wanted to have this drug because I know how to prevent HIV,” explained Danvic. “The only way for me to access it was to go to Bangkok. So you have to go there and access the check-ups and all so that you could get the drug. That was the only way before.”
With the demonstration project came promising results. First, there were no seroconversions among the 250 people enrolled in the project. In other words, no one who enrolled and stayed in the project became infected with HIV. Second, there was no significant increase in diagnosis of sexually transmitted infections among those who participated. Third, 88% of participants reported taking the drugs daily, and 99% reported to take at least 4 out of 7 pills per week. Fourth, there were also no serious side effects reported among the participants.
Highlighting the peer-driven component of the project, LoveYourself also tapped their community of volunteers to provide education and psychosocial support to the participants.
The project had limitations. This includes the small pool of participants and similarity in demographics, with almost all participants having higher education level and belonging to a higher-income bracket. Keeping these results and limitations in mind, a joint report by RITM, WHO and LoveYourself concluded that it’s possible to deliver PrEP in the Philippines in a non-medical, community-based way.
“We have seen that this model can be done, it can be replicated to other community-based organizations and even other facilities in the Philippines,” said Danvic. “PrEP can be rolled out not only by medical personal but also with trained non-medical personnel, if they work hand in hand to offer the service to the community.”
Scaling up PrEP in the communities
From the success of the demonstration project, LoveYourself scaled up and instituted the PrEP Pilipinas programme in June 2019. PrEP is now offered in LoveYourself facilities.
“Right now, it’s out of pocket,” said Danvic. “The drug costs around 1,500 pesos per bottle. It contains 30 tablets per bottle, so it’s good for one month if you take it daily. And there are also some service costs just to sustain the programme. So for you to start, you need around 2,000 pesos but the price decreases as you continue to take the medication and you access it at LoveYourself facilities.”
Danvic Rosadiño shows a bottle of PrEP to a client at LoveYourself Anglo. WHO/F. Tanggol
“This is mostly offered in community-based organizations because the community wants to access them in organizations that they feel they are safe spaces to them. There are other community-based organizations that will be offering PrEP soon, one in Iloilo, one in Davao. Other community-based organizations are also contacting us so that they could also offer PrEP. So soon, very soon,” he added.
Aside from LoveYourself, there are also private doctors who provide PrEP as well, giving people the option where they want to access it.
There are now 450 already enrolled in PrEP Pilipinas and it is slowly growing. LoveYourself is working with their volunteers and influencers to ramp up the marketing and promotion of this pill. They have posted social media cards with influencers to market PrEP in the country.
A sample social media card used by LoveYourself to market PrEP in the Philippines. PrEP Pilipinas
“With regards to cost [in marketing], it’s very minimal because we don’t pay the influencers for our photo shoot with them. Even the crafting of the messages, they’re all done by volunteers,” said Danvic. “So it’s really a community effort to reach out to other people and to spread out the messaging that PrEP is here in the Philippines.”