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Brigid Cakouros

School of Public Health, DrPH student

Bio

A Brigid Cakouros is a second year DrPH candidate at the School of Public Health. Her research interests focus on applying a systems thinking approach to research translation, program design, and implementation science in order to develop sustainable health interventions, specifically in low resource settings. She has worked in a variety of roles before returning to school, including as an analyst on vaccine supply chain logistics, an advisor for a Global Fund application, and a research coordinator in a mixed methods research lab. During her MPH, Brigid worked at the MIDAS (Models of Infectious Disease Agent Study) Center of Excellence on models studying both measles and influenza vaccination uptake and refusal. She is particularly interested in the intersection of supply and demand as it relates to program planning and delivery. Brigid received both her MPH (Behavioral and Community Health Science, 2012) and her BA (Writing, 2009) from the University of Pittsburgh.
Fellowship Proposal

More than 33 million people are living with HIV worldwide with roughly two million new cases each year. As methods of treatment are becoming more available, it is critical to continue to prevent new cases. In recent years, oral pre-exposure prophylaxis (PrEP) has become an intervention with the potential to help lower the number of new HIV positive individuals. In July 2012, the WHO recommended the use of PrEP among populations such as sero-discordant couples (SDC), men who have sex with men (MSM), and transgender women who have sex with men. More recently in November 2015, the WHO broadened its population definition and recommended that PrEP be included in a comprehensive package offered to all populations at substantial risk of exposure to HIV. While there is a fair amount of data on offering PrEP to the above specific populations, there is limited data on the impact of PrEP being a part of a comprehensive HIV prevention package to be offered at public clinics.

As PrEP was included in the 2016 National Guidelines for Antiretroviral Therapy for the Prevention and Treatment of HIV in Zimbabwe, the Ministry of Health and Child Care (MoHCC) intends to begin rollout of offering PrEP as part of the comprehensive HIV prevention package to public clinics in early 2018. Brigid will work as a part of the Clinton Health Access Initiative (CHAI) team in Zimbabwe, along with the MoHCC and the Zimbabwean National Family Planning Council (ZNFPC), to help develop a protocol to determine facilitators and barriers of those who accept PrEP during a pilot starting in July 2017. This study will use qualitative data to explore themes as to why people accept PrEP and what helps them to continue or discontinue use. Alongside findings from another CHAI-affiliated study, which intends to evaluate the clinical operations of PrEP delivery, these results will help inform the MoHCC for future design and scale up activities.

Brigid hopes that by better understanding the client perspectives of using oral PrEP in conjunction with data on the logistical opportunities and challenges of delivering PrEP, Zimbabwe will be able to design a well-informed and successful scale up across the country. In addition, this study has potential to further the discussions globally on the feasibility of PrEP as a routine HIV prevention method.