Rolling Out PrEP in Nigeria in the Context of COVID-19

July 2nd, 2020 | Viewpoint

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A unique training approach is supporting Nigeria’s rollout of oral pre-exposure prophylaxis (PrEP) for HIV prevention. The approach, combining individual self-paced learning with webinar-based support, could facilitate training across an array of contexts and topics.

The current COVID-19 pandemic has forced many HIV programs to change what they do and how they do it, including using online training platforms or e-Learning rather than in-person training for health care providers supporting HIV interventions. Online training platforms have their limitations, however, and so far have been used primarily as a precursor to in-person classroom training for providers, allowing for less time spent in the classroom away from busy clinics.

Experience from countries implementing PrEP has shown that health care providers play a critical role in ensuring successful uptake and continuation of PrEP by priority groups at high risk of HIV. Just as Nigeria began to scale up PrEP for HIV prevention in early 2020, the advent of the COVID pandemic made it unlikely that classroom training to support providers could happen any time in the near future. In May 2020, to begin building a core group of knowledgeable providers— key to increasing PrEP uptake—USAID Nigeria asked AIDSFree to organize and facilitate virtual PrEP training for its partners implementing PrEP, using the Oral PrEP eLearning course developed by WHO and Jhpiego. This introduces clinicians to PrEP, helping them identify eligible clients, counsel about safety and efficacy, manage usage, and address special situations.

From JSI’s experience using eLearning to train over 1,100 health care providers from over a dozen African countries in Voluntary Medical Male Circumcision through the Online Training Hub (OTH), the team understood challenges many learners face with online training modules, which led them to supplement the WHO Oral PrEP eLearning course with additional support activities, including two meet-up webinar discussions with clinical expert panelists. This training activity helped prepare an initial cohort of 60 Nigerian PrEP practitioners to provide PrEP to eligible Nigerian clients.

Case managers, nurses, clinicians, counselors, and pharmacists nominated by USAID’s implementing partners completed the first two training modules on their own and were invited to join a webinar discussion facilitated by two PrEP experts. These experts helped to review the material covered and clarify technical questions and considerations for providing PrEP in the Nigerian context. During the week following the first webinar, providers completed training modules three and four, and then joined the second meet-up webinar, facilitated by two PrEP experts. Following each webinar, participants received a recording of the webinar and the presenters’ slides, along with presenters’ written responses to the questions asked during the webinar. JSI/AIDSFree staff in Nigeria stayed in close touch by email and phone with the training participants throughout, reminding them to complete the modules, troubleshooting problems, and inviting them to join the webinars. Participants who finished all four modules received a printable certificate showing that they had completed the course.

A cohort of 60 participants completed all four modules and attended both webinars. An evaluation administered at the end of the second webinar showed that 91 percent of attendees found the webinars “helpful” or “very helpful”; 80 percent reported that the webinar format enabled them to ask questions and clarify their understanding.

Although internet connectivity was a challenge, over three-fourths of participants rated the course overall as “excellent” or “very good.” A participating nurse commented, “With the training we just had, my knowledge…is far better than what I knew and it has also influenced the way we approach our clients…with the help of the training, I can identify the clients to initiate for PrEP.”

Building on the success of the first Oral PrEP eLearning course in Nigeria, JSI/AIDSFree is planning to train additional cohorts of providers in Nigeria in the coming months. With online learning here to stay for the foreseeable future, this approach of enhancing individual self- paced learning with webinar-based support could be applied to health provider training in other topic areas and settings.

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