JMIR Publications

ABSTRACT

Background:

The rapid growth of the South African e-commerce sector and increasing acceptance of digital health technologies largely facilitated by the COVID 19 pandemic present an opportunity to overcome traditional barriers to oral pre-exposure prophylaxis (PrEP) for HIV prevention by leveraging online platforms for PrEP delivery. This study was conducted to develop and evaluate an end-to-end online PrEP delivery model. This paper reports on early insights into its feasibility and acceptability.

Objective:

This study was conducted to develop and evaluate an end-to-end online PrEP delivery model. This paper reports on early insights into its feasibility and acceptability

Methods:

Market research surveys and in-depth interviews (IDI’s) were conducted with potential PrEP clients accessing community pharmacies, to obtain preferences for PrEP delivery and gain insights into the proposed online delivery model prior to implementation. We partnered with King Online an online health and wellness e-commerce company to develop an online PrEP user platform. Individuals aged 18 years and older, residing in Gauteng Province, South Africa accessing the website could order a free HIV self-test (HIVST), report HIV results and schedule a once-off nurse for PrEP initiation in accordance with national guidelines. PrEP refills were supported by HIVST’s, dry blood spot (DBS) self-sampling (for confirmation of self-reported HIV status), telemedicine consults and courier delivery of PrEP. Demand generation strategies used to direct traffic to the website included search engine optimisation, local radio and social media adverts. We measured the number of HIVST kits delivered through the online platform, subsequent PrEP uptake, socio-demographic and sexual behavioural characteristics of participants enrolled for the period June 2023 to July 2024. IDI’s were conducted with online PrEP users between their 6th and 7th months in the study and a representative of the online platform as a key informant for insights on operational experiences with the online PrEP delivery model.

Results:

Of the 127 potential PrEP clients who completed the market research surveys on preferences for PrEP delivery, 75.6% (96/127) preferred to access PrEP from pharmacies followed by online platforms (17/127, 13.4%) and 6.3% (8/127) preferred local clinics. A total of 567 individuals ordered HIVST kits, of these 155 (27.3%) were successfully initiated on PrEP after successfully reporting an HIVST result and scheduling a nurse home visit. The median age of participants was 31 years, majority were male (97/155, 62.6%), single or never married (127/155, 81.9%), tertiary educated (123/155, 79.4%) and formally employed (110/155, 71%). Most participants were PrEP-naïve (121/155, 78%) and engaging in condomless sex (92/155, 59%). Key drivers of acceptability from potential and actual users included privacy, convenience, and ease of access whilst recommendations highlighted the need to streamline online PrEP processes and improve efficiencies.

Conclusions:

The online PrEP delivery model in Gauteng province was feasible and acceptable, offering a promising differentiated approach to HIV prevention especially for urban populations with high digital access. With refinement, such models could play a critical role in reaching at-risk populations.