In January 2021, a pilot was launched in Skopje to introduce PrEP. It will run for 12 months and will target 100 people representing MSM, sex workers and transgender people. The pilot will provide PrEP as part of a broader sexual health package. The PrEP pilot includes a research component to analyze the model of service provision, design any necessary improvements and changes, and develop advocacy efforts for further expansion and sustainability.

With the launch of the pilot, North Macedonia became one of the first countries in the Balkan region to introduce pre-exposure prophylaxis.

“The Working Group on the pilot implementation began its work in 2020. It was able to overcome some logistical difficulties and, despite the impact of the COVID-19 pandemic, to prepare the operational research for the pilot earlier this year,” Stronger Together said.

All stages of the procurement process for drugs for the PrEP pilot were coordinated by the Alliance for Public Health team, and thanks to international procurement mechanisms the cost of the purchased drugs was 5 times lower than the cost of the same drugs procured by North Macedonia.

“We will continue to support our partners in North Macedonia throughout the entire period of the PrEP pilot, also within the research component, providing the necessary technical assistance,” Alliance for Public Health said.

The launch and implementation of the pilot is the result of collaboration between Stronger Together, the Association for the Support of People Living with HIV in North Macedonia, and the Alliance for Public Health, with financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, as part of the regional project “Sustainability of Services for Key Populations in the EECA and SEE region” (SoS_project).

It should be noted that with the expert and financial support of the Alliance for Public Health and the SoS_project team in North Macedonia in 2020, a protocol for PrEP pilot in the format of an operational research as well as the first national recommendations for pre-exposure prophylaxis in the context of sexual health were developed.

This pilot in North Macedonia is being implemented through a partnership co-financing model of three partners: SoS_project, the Clinic of Infectious Diseases and the National Health Insurance Fund.

Importantly, implementation of PrEP services in North Macedonia is designed to integrate PrEP into healthcare system after piloting, which is expected to contribute to its sustainability after the end of the SoS project in North Macedonia.