TABLE 2.
Timeline of Key Activities Implemented During Oral PrEP Service Delivery Program for PWID, Bayelsa and Niger States, Nigeria
| Date | Activity | Description/Stakeholders Involved |
|---|---|---|
| December 2019 | Commenced HIV program implementation | Initiated HIV services, except oral PrEP, through PWID-focused CBOs to engage PWID PWID engaged during this initial outreach effort helped to identify PWID community leaders who were engaged in the subsequent mapping exercise for oral PrEP programming. Peer outreach workers were also identified through this initial outreach effort allowing for more peer-led efforts for oral PrEP demand creation. |
| January–March 2020 | Conducted mapping and size estimation | Mapped PWID communities in both states to identify PWID hotspots where oral PrEP demand creation and services can be provided, estimated the size of the population, identified available services, and planned for scale-up of oral PrEP services |
| February 2020 | Initiated prevention services | Initiated oral PrEP services tailored to PWID in both states |
| March–October 2020 | Initiated strategies to continue services through COVID-19 lockdown | Adjusted oral PrEP service outreach hours among peer outreach workers to accommodate curfew time and lockdown periods Provided virtual case management and telemedicine for PWID clients for continued oral PrEP demand creation and adherence support Provided virtual supportive supervision, mentoring, and capacity building for staff of CBOs and for peer outreach workers providing oral PrEP Negotiated with the government to permit movement for HIV service and commodity provision, including oral PrEP, during periods of lockdown |
| March–April 2020 | Oriented stakeholders at monthly interface meetings | Included 72 CBO staff, the PWID community, the Niger and Bayelsa state governments, the Nigerian Police Force, NSCDC, NDLEA, and community vigilante teams Introduced the EpiC program to all stakeholders Oriented stakeholders on importance of access to health care and HIV prevention, such as oral PrEP, for PWID without fear of being arrested Educated the PWID community about availability of an arrest-free rehabilitation program provided by the NDLEA to address some fear of arrest among the PWID community that prevent them from seeking and accessing health services, including oral PrEP |
| March–April 2020 | Provided trainings on human rights and stigma and discrimination | Included 104 CBO staff, health care providers, paralegal security personnel, community vigilante teams, NSCDC, SACA, and SASCP Created awareness on human rights and fostered collaboration between the community and law enforcement agencies to foster an enabling environment where individuals of the PWID community feel safe in accessing health services, such as oral PrEP Educated participants on the barriers to providing quality and comprehensive HIV services to PWID Brought to attention the stigma and discrimination faced by the PWID population as a barrier to them accessing necessary health services, including oral PrEP, and the efforts needed to address this |
| July 2020 | Engaged oral PrEP champions | Included 6 oral PrEP champions (members of the PWID community who were on oral PrEP) responsible for providing peers with information about oral PrEP and supporting adherence and continuation Raised awareness of oral PrEP and its benefits among PWID Encouraged PWID with ongoing risk to continue oral PrEP usage |
| July–August 2020 | Held community dialogues | Held 2 discussions with 8 PWID community leaders, 6 security personnel, and government agency representatives to increase awareness of the importance of ensuring PWID have access to comprehensive HIV care and to increase demand for health services and oral PrEP among PWID |
| July–August 2020 | Sensitized KP community on oral PrEP | 2 meetings included 8 KP community leaders, among them PWID community leaders Sensitized KP leaders on oral PrEP benefits for PWID to encourage their support in demand creation and promotion among the PWID community |
| August 2020 | Conducted oral PrEP drive | Worked with members of the PWID community and peer outreach workers to conduct periodic surges of outreach activities to increase oral PrEP screening and uptake among PWID |
| August 2020 | Trained peer outreach workers in motivational counseling | Included 10 PWID peer outreach workers in training on how to motivate PWID to take oral PrEP and access other HIV prevention, care, and treatment services Improved counseling and communication skills among all peer outreach workers |
| November 2020 | Trained PWID on as paralegals | Trained 30 PWID as paralegals to interface with security agencies in cases of harassment or discrimination against PWID community members to improve confidence among the PWID community in their security when accessing health services, including oral PrEP |
Abbreviations: CBO, community-based organization; EpiC, Meeting Targets and Maintaining Epidemic Control; KP, key population; NDLEA, National Drug Law Enforcement Agency; NSCDC, Nigerian Security and Civil Defense Corps; PrEP, preexposure prophylaxis; PWID, people who inject drugs; SACA, State Agencies for the Control of AIDS; SASCP, State AIDS and STD Control Programme.