SRH mobile clinic procedures
syphilis, adolescent-, gonorrhoea, chlamydia
HEPATITIS B, STIS, SYPHILIS, GONORRHOEA, ADVERSE EFFECTS
The SRH mobile clinics visit the intervention clusters every 2 weeks. The clinics deliver nurse-led HIV testing, prevention and care including adolescent- and youth-friendly, gender neutral, HIV status neutral, individualized risk assessments for HIV care and PrEP, integrated with SRH services (one stop shops). During the SRH clinic appointment, participants will receive counselling around sexual health, fertility intentions, contraception and HIV. This is part of sexual health counselling with PrEP to stay negative or ART to stay well and virally suppressed (undetectable = uninfectious). All clinic attendees are offered pregnancy testing (if female), family planning support, choice of contraception, and syndromic management for STIs, and, if male, referral to voluntary medical male circumcision. Everyone is offered HIV counselling and POCT, and immediate initiation of ART if positive. All those who are HIV negative undergo screening for PrEP eligibility according to South African National guidelines. Those who are sexually active are also offered testing for STIs, including POCT for syphilis and hepatitis B (and vaccine if negative), self-taken vaginal swabs or urine tests for gonorrhoea and chlamydia, and treatment and partner notification if positive.If the participant agrees to immediate PrEP/ART initiation, s/he is issued with a month’s supply of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) or ART. Participants receive a phone call seven days after initiating PrEP/ART to complete a standard symptom screen for adverse effects and be referred to a fixed PHC for care if necessary. Participants have a mobile clinic appointment scheduled one month after PrEP/ART initiation. As per national guidelines, mobile clinic appointments for refills and monitoring are every 3 months thereafter; we provide community refills aiming for continuous PrEP supplies. If they agree, participants are referred back to peer navigators for adherence support and to ensure clinical follow-up. The electronic clinical management tool facilitates secure bidirectional communication of case-based action plans between the mobile clinic, the oversight committee and the peer navigator teams in the cluster.