Carolyne Akello

The CATALYST study set out to show how PrEP choice works in routine public health services. Funded by PEPFAR/USAID, this multi-country implementation study offered women a choice of oral PrEP, the dapivirine vaginal ring and injectable cabotegravir (CAB PrEP) at 28 public health sites in Kenya, Lesotho, South Africa, Uganda and Zimbabwe. Enrolment began in May 2023. In Uganda, where I served as Principal Investigator, the local partner TASO delivered the study at seven public health sites in the Western, Eastern and Northern regions.

In January 2025, CATALYST was shut down one year earlier than planned as part of the U.S. foreign aid cuts. The termination notice came without warning and required all study activities to stop immediately. We could not follow normal study close-out procedures, but we did what we could to protect the study participants. In Uganda, site officers contacted 99% of participants to inform them of the study termination and refer them to routine PrEP services. We also informed the ethics committee, the Uganda National Council for Science and Technology, the Ministry of Health, district health management teams, and Community Advisory Boards. ViiV Healthcare and Population Council donated the remaining 2,100 vials of CAB PrEP and 5,700 rings from the study to the Ministry of Health, which made them available to clients at the seven sites through routine services. What we could not do was go back to the participants, providers, and communities who made the study possible and share what we had learned.

Project Resource Optimization (PRO) has filled that gap. PRO funding has allowed several of the original study partners to analyze data collected before the study closed. Just as important, it has enabled us to take the results back to the communities that made the study possible, hear their feedback, and learn how they still matter for PrEP programs today.

Where we shared the results

Between 18 and 27 August 2026, the Root to Rise team in Uganda shared the results in Mbarara, Gulu and Mbale, covering the three former CATALYST regions. We presented several analyses, including multi-country and Uganda-specific PrEP uptake and continuation data by product and sub-population, client and provider experiences with PrEP choice services, and lessons from the quality improvement collaborative on local adaptations sites made to the PrEP choice delivery package. We met district and city health teams, facility in-charges, PrEP providers, PrEP ambassadors, TASO site officers, Community Advisory Board members, and implementing partners. On 11 September, we presented to the national PrEP Technical Working Group in Kampala, with representatives of the Ministry of Health, the Uganda AIDS Commission, PEPFAR, UN agencies, civil society and young people.

What we heard

“The study did not go down the drain,” said a PrEP provider. “You came back! Some people never return, but you have returned to share results with us!” said a Community Advisory Board chairperson.

Community Advisory Board members were also honest about what followed close-out. After the aid cuts, PrEP services were heavily disrupted. Some providers were let go, and the Ministry of Health’s move to integrate services at all delivery points brought reduced privacy, long waiting times, and overwhelmed staff. As a result, far fewer clients accessed PrEP, including CATALYST participants. Moreover, some were told oral PrEP was only for pregnant and breastfeeding women. Inconsistent supplies and short-expiry oral PrEP further eroded confidence that PrEP would stay available. Members cautioned that strict adherence to global guidance may have compromised participants’ dignity and wellbeing. They called for contingency plans so that, if a study closes unexpectedly, participants keep essential services, especially immediate access to PrEP.

The importance of choice ran through every discussion. Stakeholders asked that a range of prevention options stay available within routine services, and that PrEP choice reach beyond the former study sites, particularly in rural communities. However, which options to position within the national PrEP portfolio needs further discussion with the Ministry of Health leadership team. They also raised concerns that provider practices may favour injectable PrEP, and called for balanced, client-centred counselling on all methods. 

Commodity security came up at every level. Recent stock-outs of lenacapavir (LEN) PrEP and CAB PrEP, and short-expiry oral PrEP, have put community confidence in PrEP services at risk in Uganda. A City Health Officer said the results have equipped community members to raise awareness and generate demand, but warned: “It is essential to ensure adequate availability of commodities at health facilities; otherwise, these efforts will not achieve their intended purpose.”

Stakeholders agreed that demand generation and community engagement should be institutionalized as a continuous PrEP program function rather than treated as a one-off activity linked to individual product introductions. Given concerns about increasing HIV infections, there is an urgent need to intensify prevention awareness, access and uptake.

Looking ahead

Uganda now offers oral PrEP in 776 facilities, the PrEP ring in 11, CAB PrEP in 68, and LEN in 104. Evidence from the study has been used to inform implementation of PrEP choice beyond the seven CATALYST facilities and to strengthen the health system for PrEP delivery.

In the words of one Community Advisory Board member, “CATALYST was truly catalytic, as its name suggests, in advancing PrEP choice in Uganda.” The study closed early, but the communities who made it possible are still here and still asking the right questions. We owe it to them to keep coming back.