The shift in 2022
Twenty-two was the year EpiC moved oral pre-exposure prophylaxis (PrEP) from a pilot offer to a standard menu item for every eligible KVP contact. Eligibility screening was embedded into every HIV-negative test result, and PrEP starts were delivered same-day wherever the supply chain allowed.
Eight hundred and sixty KVPs initiated PrEP across the six councils, a 3.4-fold increase on the 2021 baseline. Female sex workers accounted for 47 percent of initiations, AGYW for 28 percent, and men who have sex with men for 11 percent.
The continuation question
The harder question is not who starts PrEP — it is who is still on it three and six months later. Three-month continuation across the year was 71 percent; six-month continuation was 62 percent.
Discontinuation interviews surfaced three dominant reasons: a reduction in perceived risk, side-effect intolerance in the first two weeks, and refill inconvenience. Each is being addressed differently — a structured month-one check-in, a side-effect anticipatory counselling script, and a community-pickup refill model piloted in two councils.
PEP and condoms
Post-exposure prophylaxis (PEP) was issued to 140 individuals during the year, predominantly after sexual violence and condom failure events. All 140 completed the 28-day course, and follow-up testing at week six confirmed zero seroconversions.
Approximately 3,200 condoms continue to be distributed weekly through peers, drop-in centres, and KVP-friendly entertainment venues — a quiet but essential layer of the biomedical stack.
PrEP scale-up succeeds when initiation, refill, and continuation are treated as three separate, equally engineered services.