Hub and Spoke Planning Grant

Implementation Experiment to facilitate the creation of an appropriate and receptive environment for effective use of existing and new HIV prevention products to maximize their impact as they become available for AGYW in Gauteng province, South Africa.


The HIV epidemic in South Africa has evolved from a state of emergency with high mortality, to one showing the benefits of a huge expansion of treatment services and wide coverage. The epidemic is not homogenous, disproportionately affecting Adolescent Girls and Young Women (AGYW) and key populations such as sex workers and men who have sex with men. Annually, over a third of all new HIV infections in South Africa occur in youth (age 15-29), with young women three times more likely to be infected than their male counterparts. HIV transmission vulnerability and dynamics vary depending on age and sex so effective prevention and treatment interventions need to be age and sex responsive. Oral PrEP has been made available in South Africa since 2016 targeting priority populations, more recently including AGYW. National guidelines highlight the need for a comprehensive package of SRHR services for AGYW and data from ongoing PrEP programs show that AGYW have multiple service needs, a high proportion being in school or college. Existing data highlight significant challenges to SRHR service access and to daily pill taking; these are yet to be overcome. New longer acting HIV prevention options may result in better uptake and continuation and overcome some barriers to effective use. In addition to individual client level barriers to optimal uptake, these programs also highlight the need to strengthen: 1) the service delivery platform; 2) strategies for demand creation (“attract, engage and enable”), 3) the provision of youth friendly services and the delivery of a full SRHR package within which HIV biomedical prevention technologies could be delivered. Oral PrEP scale- up is currently underway nationally but slowed down significantly due to the COVID-19 pandemic. However; the emergence of COVID-19 pandemic pushed programs to adapt rapidly by strengthening linkages with private and NGO service providers, using online and decentralized approaches as well as the use of digital innovations, remote support systems and self-care to ensure a quick rebound in oral PrEP uptake. The evidence-base on these innovations is sparse and will be strengthened through this proposed research. Furthermore, the recent European Medical Association (EMA) approval of newer PrEP modalities such as the Dapivirine intravaginal ring (DPV) and the encouraging clinical trial results on injectable long acting Cabotegravir (LA CAB) which is in advanced stages of the introductory and trial pipeline present opportunities for expanded choice and reach.

Primary Objectives

To determine the acceptability and beneficiary preferences and pathways of existing and new HIV prevention and SRH service delivery models by analyzing routine monitoring, evaluation data and existing research on all aspects of various service delivery models. Specifically: a) examine the acceptability of current demand and uptake pathways for existing SRHR products including HIV testing and prevention; b) examine current demand creations strategies and identify client patterns and preferences of interacting with demand creation content that lead to uptake and continuation
Determine best practices in SRH delivery and COVID-responsive programming to further leverage for innovations.
Examine the acceptability of proposed health service innovations with potential end users and implementers
Conduct a stakeholder consultation during the design phase to ensure the development of a joint implementation plan. This will ensure that the mechanisms and activities identified for implementation have been agreed to upfront through a joint process thereby leading to better buy-in and approval from government.
Design, develop and pilot test the range of additional spoke and UPIs, digital and decentralized, self-care options. •
Identify data needs and M&E systems for evaluation.

Investigator and Project Contacts

  • Principal Investigator – Prof. Saiqa Mullick
  • Co-Investigator – Ms. Vusile Butler


  • Bill and Melinda Gates Foundation (BMGF)

Latest Update:

15 February 2021

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Research and Policy Briefs

Project Brief: Hub and Spoke Planning Grant

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