Roll-out of first HIV pre-exposure prophylaxis services in the Democratic Republic of the Congo

Background: In the Democratic Republic of the Congo (DR Congo), HIV prevalence is highest in key populations, specifically female sex workers and men who have sex with men, with estimates of 7% and 18%, respectively, compared with 1·2% in the general population. Pre-exposure prophylaxis (PrEP) is an evidence-based intervention to reduce HIV incidence in populations who are at substantial risk of acquiring HIV. Building the capacity of clinics and outreach programmes serving key populations is a critical first step in scaling-up PrEP services. Here, we describe a programme from the DR Congo's National AIDS Control Programme, US Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University to initiate 350 clients from key population on PrEP in 2018. Methods: With support from the National AIDS Control Programme and CDC, ICAP facilitated PrEP implementation at seven HIV care and treatment facilities in DR Congo. Capacity-building activities included: guidance on national planning; establishment of a national PrEP technical working group; and the development of PrEP training material for multidisciplinary facility teams to provide and monitor PrEP services. Training addressed: PrEP eligibility screening, initiation, and follow-up; PrEP retention and follow-up activities; and monitoring and evaluation of PrEP services. ICAP also provided ongoing on-site mentorship of clinic staff, and continuous evaluation of clinic procedures to ensure standardised PrEP service delivery across all facilities. Findings: By February, 2018, 38 clinical staff and 48 peer outreach workers had completed a 6-day PrEP training course using ICAP's PrEP training curriculum; participant and facilitator manuals; job aids; and monitoring, evaluation, and reporting tools. Following the training, four sites in Kinshasa and three sites in Lubumbashi initiated PrEP services for the first time, resulting in successful achievement of the national PrEP targets. Interpretation: Collaboration between national and global stakeholders resulted in the successful introduction of PrEP in DR Congo. PrEP implementation required extensive clinic training, tailoring of existing outreach activities to improve PrEP retention, inclusion of peer workers to help educate patients about PrEP, comprehensive monitoring and evaluation reporting, and ongoing mentoring of clinic staff. Lessons learned in DR Congo will be shared with other programmes in African countries that work with populations at risk of HIV. Project findings will also support the endorsement of national PrEP guidelines and the scale-up of PrEP in DR Congo. Funding: US Centers for Disease Control and Prevention