Reaching Men and Women Through a Decentralized Mobile Service Delivery Model for HIV Prevention and Pre-Exposure Prophylaxis Services in South Africa

Abstract

INTRODUCTION: Structural and service delivery barriers such as long waiting times, health care provider attitudes, and distance from services prevent access to HIV prevention and pre-exposure prophylaxis (PrEP) services, particularly for young people. The World Health Organization recommends differentiated service delivery models for HIV prevention and treatment services, including through mobile outreach. Mobile health clinics offer an opportunity to overcome barriers to service access by bringing services closer to places of work or study, improving convenience, minimizing stigma, and expanding the choice of service delivery locations and types. METHODS: We conducted a mixed-methods study describing a mobile service delivery model for HIV prevention and PrEP services in 3 provinces in South Africa. The study used routine program monitoring and evaluation data from 35,375 men and women aged ≥15 years accessing services at project fixed facility and mobile clinic sites between January 2019 and October 2022, in addition to data from 74 in-depth interviews with a purposively selected sample of adolescent girls and young women aged 15-24 years and men aged ≥15 years enrolled in a nested study cohort. RESULTS: Overall, 11,687 people were reached through mobile clinics between January 2019 and October 2022, of whom the majority were female (89.3%) and between 15-24 years (82.8%). Nearly all (96.0%) mobile clinic clients received an HIV test and 80.8% initiated oral PrEP, similar to HIV testing and PrEP initiation rates at the fixed facilities. Health care users demonstrated a high level of satisfaction with mobile health services, with benefits including a reduction in trips to fixed facilities, improved privacy, and reduced waiting times. However, some participants noted challenges with mobile services, including inconsistent schedules. CONCLUSION: Mobile health services with youth-friendly staff have the potential to reach young people in need of HIV prevention services and are feasible and acceptable in the South African setting. Mobile health services offered benefits such as convenience, privacy, and reduced need to travel to clinics, although they could be enhanced through improved consistency of services.