Making women's options for HIV prevention in Tanzania accessible and joining implementation science capacity building (MWOTAJI) - SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face a disproportionate burden of HIV infection. Though highly effective HIV prevention like pre-exposure prophylaxis (PrEP) is central to the global strategy for HIV epidemic control, awareness of PrEP among AGYW is low, with uptake and continuation even lower—health systems are often ill equipped to overcome the numerous access barriers faced by AGYW, including stigma, harmful norms, and the inconveniences of clinic-based health services. There is growing recognition that community-based pharmacies have the potential to bridge gaps in HIV prevention and mitigate access barriers among AGYW. Thus, the goal of this study is to evaluate the Malkia Klabu (“Queen Club”) implementation strategy in Tanzania, a loyalty program designed for and by AGYW that creates youth-friendly pharmacies where AGYW can access HIV prevention and sexual and reproductive health (SRH) services, with strong linkages to facility-based care. Based on promising data from our pilot study, we hypothesize that the creation of a welcoming and safe pharmacy environment through the Malkia Klabu implementation model will attract AGYW and bolster uptake of PrEP, HIV self-testing (HIVST), and other SRH services, thereby empowering AGYW to avoid HIV and unintended pregnancy. We have designed an innovative, 5-year implementation science study to scale and evaluate several models of Malkia Klabu’s pharmacy-based approach for PrEP and HIVST delivery in five research sites in Lake Zone, Tanzania using the RE-AIM framework. This research will be enhanced by implementation science training of local researchers and policymakers to optimize Malkia Klabu and benefit future HIV prevention strategies. We will first conduct a Type 3 Hybrid Implementation-Effectiveness study of four pharmacy-based differentiated PrEP delivery models of Malkia Klabu in 50 pharmacies, examining implementation outcomes before and after the addition of user cost-sharing which is essential for real-world sustainability (Aim 1). We will examine the success of the Malkia Klabu delivery models on effective use of PrEP among a cohort of 575 AGYW, reach of the program in a cross-sectional household survey with 750 AGYW in study areas; pharmacy exit surveys with ~200 AGYW will help describe the success of pharmacy- based PrEP service offerings (Aim 2). A Certificate in Implementation Science coupled with seed grants for graduates will ensure the project has lasting impact (Aim 3). At the study’s conclusion, we will determine the strongest and most sustainable version of the Malkia Klabu implementation strategy for pharmacy-based PrEP and HIVST delivery to AGYW, and launched an implementation science training program to enable locally-led scaling and adaptation to reach vulnerable AGYW across Tanzania and the Region. The project is a collaboration between Mzumbe University, Health for a Prosperous Nation, the Tanzania Ministry of Health, and University of California (San Francisco & Berkeley).
