1. PreP Adherence Clubs

2. MSF ART Adherence clubs ART Adherence clubs are long term retention model of care catering for stable ART patients Based on a quick clinical assessment, 2monthly ART collection, peer support and simplified monitoring ARTclubs were piloted by MSF in Khayelitsha. Over a 40 month period 97% patients remained in care.

3. CLUB STRUCTURE MAX 30 As close to home as possible Library or fellow peer’s house Meet 2 monthly Collect 2m of PreP At every visit quick clinical assessment for symptoms of acute HIV infection and pregnancy If at any time miss NMP must report to clinic for Pregnancy test – if pregnant must be strated on triple regimen

4. CLUB ORGANOGRAM Facility Manager Clubs Manager Club facilitator Club nurse Pharmacist Data Capturer Ensure buy in of all facility staff

5. PreP with Truvada Truvada = TDF (tenofovir) + emtricitabine Tenofovir is known for kidney toxicity Careful kidney monitoring needs to be done according to National Guidelines Patients need to be motivated to stay on PreP - to prevent resistance CDC guidelines for PreP is a good source of knowledge Tenofovir is not yet approved for adolescents – how are girls 15+ going to be approaced in this type of club or are they excluded Adolescents have special needs and need to be in clubs separate from adults to ensure optimal adherence

6. Criteria to be allowed on PreP and Monitoring HIV negative No Symptoms of acute HIV infection (window period) Normal renal function No contraindicated medications No Chronic diseases requiring clinic monitoring? 3 monthly HIV testing to exclude incident infection Motivated Documented Hep B status and vaccination status Renal function at baseline and according to National Guidelines Risk reduction services Pregnancy tests how often?