Introduction

The Philippines is experiencing the steepest rise in HIV in the region, with new infections up by 200% between 2010 and 2018. The country is facing a rapidly rising HIV epidemic among young men who have sex with men (MSM). Testing rates among young populations is poor. HIV self-testing (HIVST) is a promising strategy to address this testing gap. To date, very little research has been conducted in the Philippines regarding HIVST. 

Whilst stigma is a barrier to HIV testing in general the converse is also true that the convenience and confidentiality provided by HIVST may make it an attractive approach to programmers. Furthermore, individuals who test negative have the potential to be linked to other HIV prevention methods such as pre-exposure prophylaxis (PrEP). 

PrEP 

1-Roll out of Prep at country level

PrEP was introduced to the Philippines in 2017 through Project PrEPPY; a multi-stakeholder pilot project launched and spearheaded by the community-based organization, LoveYourself, Philippines. 

Project PrEPPY employs a demedicalized approach to PrEP implementation with task-sharing among community volunteers (PrEPPY peers) who are trained to provide specialised PrEP services and drug dispensing. The demonstration project had a high follow-up rate and high adherence to PrEP, confirming the importance of peer-driven approaches to PrEP service delivery for the further role out of PrEP in the Philippines. 

Additional findings from this demonstration project show that there have been no new HIV infections among enrolled clients over the two-year project cycle, no increase in STI incidence, no increase in the number of sexual partners, more than 80% follow-up at 3 months and no change in condom use with casual partners. 

Lessons learned from the demonstration project were: 

●   The importance of minimising enrolment and processing times (enrolment was reduced from 5 hours to 1.5-2 hours). 

●   The vital role of peer-driven and community-based approaches for making PrEP accessible and acceptable. 

●   Streamlining services by integrating PrEPPY referral into other online initiatives. 

●   The influential role of client-centred demand generation campaigns, which use ambassadors to communicate the key messaging of PrEP. 

●   Importance of providing multiple access points to PrEP services (including online), to provide clients with more choice

In October 2019, a successful client-centered online campaign was launched: #MenOfPrEP campaign targeting men who have sex with men and #QueensOfPrEP targeting transgender women. The demonstration project also led to the establishment of a National PrEP Network in the Philippines, which serves as a hub for PrEP service providers to share examples of best practice and resources for PrEP implementation. Through this network, support and training has been provided to public health providers, including using an online platform during the COVID-19 pandemic.

In quantitative terms the result of the campaign was as follows:

Lessons learned from this campaign were:

●   The community can create demand generation activities to increase service uptake

●   A sex-positive campaign powered by the community is effective in building awareness of PrEP

●   Population-specific variants of the campaign are recommended that are targetted and diverse

PreP roll out plan in Philippines as mentioned in a meet hosted by UNAIDS, Unitaid and WHO in association with the Institute of HIV Research and Innovation (IHRI) in December 2020 was as follows:

As of July 2021 there were 100-300 Estimated Number of PrEP Users in Philippines.

2-Availability, accessibility and costing

As per an article in CNN Philippines (https://cnnphilippines.com) dated December 1, 2019:

There was only one FDA-approved brand in the country, and it came at a hefty price of ₱1,500 for a bottle lasting 30 days. With the funded trial over, Love Yourself continued to provide a PrEP program for anyone willing to pay a ₱2,000 fee inclusive of a month’s worth of pills, consultations, and diagnostic tests. Currently, there are about 500 people enrolled in the program, but demand for the drug is high (about 3,000 people signed up for the free trial).

There is only a handful of Love Yourself clinics scattered around Manila. And although there are dozens of DOH HIV testing and treatment centers across the country, none of these currently provide PrEP.’

There are some online pharmacies that provide medication for PrEP to Philippines like Dynamix International. PrEP can still currently be accessed locally through enrolling in Project PrEPPY (PrEP Pilipinas) a project delivering PrEP services for MSM and transgender women at high risk for HIV in Manila. For this project, HIV-negative MSM and transgender women at risk of infection are offered PrEP in LoveYourself's two clinics in Manila. Users can sign their interest at go.loveyourself.ph/prep.

In 2020-21 Covid-19 pandemic saw a drop in people availing of PrEP and other HIV related services in Philippines. But civil society and communities stepped up to the challenge to provide HIV services. For example, Family Planning Organization of the Philippines (FPOP), with a network of more than 1000 community-based services across the country worked closely with the Philippines Department of Health, local government units and other treatment hubs and support groups to serve key populations and people living with HIV. Innovative programmes that included online counselling and onsite services. telemedicine and mobile clinics were established and pre-exposure prophylaxis (PrEP) and condoms were frontloaded to community champions for distribution. HIV & AIDS Support House (HASH), another renowned community-led service provider, which in coordination with the Department of Health has worked to prevent disruption to HIV services, including PreP during COVID-19.

Are you or your network/organisation working to scale up PrEP availability and access?

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3-Status of PrEP in national guidelines

National guidelines for PrEP service have been developed and are due to be implemented soon in the Philippines.

4-Comment / Additional information