MOSAIC

Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) is a five-year (2021-2026) global project funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) to help women prevent HIV by accelerating introduction and scale-up of new and emerging biomedical prevention products.

MOSAIC will work across multiple countries including Zimbabwe to implement user-centered research and research translation efforts to identify, understand, and remove barriers to new product introduction, access, and use; coordinate and provide technical assistance to global, national, and subnational stakeholders to expedite product launch and scale-up; and strengthen the capacity of a wide range of local partners to perform essential functions that support the introduction of HIV prevention products.

The MOSAIC consortium is led by FHI 360 along with core partners Wits Reproductive Health and HIV Institute (Wits RHI), Pangaea Zimbabwe AIDS Trust (PZAT), LVCT Health, Jhpiego, and AVAC. Local partner leadership and engagement, particularly in sub-Saharan Africa, is intrinsic to the project’s approach to expediting women’s access to new HIV prevention products. The work will also be supported by technical partners from Afton Bloom, Avenir Health, Columbia University, Mann Global Health, RTI International, the University of Pittsburgh, and the University of Washington.

Working closely with product developers, MOSAIC will advance access to and uptake within a multi-product market that includes options such as oral pre-exposure prophylaxis (oral PrEP), the dapivirine ring (also called PrEP ring), and injectable long-acting cabotegravir (CAB PrEP).

Vision

Our vision is that after five years, women in sub-Saharan Africa will have access to multiple effective PrEP products that meet their changing needs and desires; that health systems will be enabled to support informed choice and effective use through policies, programming, and differentiated service delivery; and that cost, impact, and targeting guidance will be in place to support efficient use of resources.

Objective

MOSAIC’s objective is to accelerate the introduction and scale-up of new biomedical prevention products and expedite their availability, acceptance, uptake, and impact in PEPFAR programs to help individuals, especially women, prevent HIV and other infectious diseases. To achieve this objective, MOSAIC will work in alignment with five strategic priorities:

• Promote a user-centered approach in which the needs and preferences of users — especially adolescent girls and young women — are understood and addressed in product introduction and scale-up
• Conduct research to expand the evidence base on how to effectively enhance product availability, acceptability, uptake, and effective use
• Coordinate and provide technical assistance to global, national, and subnational stakeholders to expedite product introduction in policy and programs by addressing issues related to regulatory review, policy development, resource mobilization, supply chain, delivery models and platforms, monitoring and evaluation, surveillance, and demand generation
• Implement research utilization activities and establish mechanisms for rapid, effective knowledge exchange among key stakeholders to facilitate application of existing and emerging evidence on product introduction in policy and programs
• Strengthen and sustain local partner capacity to advocate for, design, and implement high-quality product introduction activities and research

The MOSAIC project will generate evidence through the CATALYST study that assesses the best approaches and identifies the core components of a service delivery package for PrEP choice. The overall goal of the study is to assess the feasibility, acceptability, uptake, patterns of use, and use effectiveness with a service delivery package providing choice of oral PrEP, PrEP ring, and CAB PrEP among women, especially AGYW, at PEPFAR/USAID delivery sites in Kenya, Lesotho, South Africa, Uganda, and Zimbabwe.

These countries were selected based on high HIV incidence among women and current or anticipated imminent introduction of PrEP ring and CAB PrEP, in addition to existing oral PrEP delivery, thus creating a feasible landscape in which to study the delivery of PrEP choice.

The programmatic objective of the CATALYST study is to deliver PrEP choice across multiple PrEP products for women in PEPFAR-USAID health service delivery sites, and facilitate a Quality Improvement (QI) Collaborative to co-design and refine the service delivery model whilst the research objectives are to:

1. Describe the implementation process for delivering PrEP choice, and assess individual, provider, facility, and health system-level facilitators and barriers of the implementation process.
2. Define patterns of PrEP use and outcomes in the context of PrEP choice, determine implementation and demographic correlates of PrEP use patterns.
3. Describe clinically relevant indicators among PrEP users.