Stand‐alone model for delivery of oral HIV pre‐exposure prophylaxis in Kenya: a single‐arm, prospective pilot evaluation

Author:

Ortblad Katrina F.1ORCID,Mogere Peter2ORCID,Omollo Victor3,Kuo Alexandra P.4ORCID,Asewe Magdaline3,Gakuo Stephen2,Roche Stephanie1,Mugambi Mary5,Mugambi Melissa Latigo6,Stergachis Andy46,Odoyo Josephine3,Bukusi Elizabeth A.67ORCID,Ngure Kenneth68ORCID,Baeten Jared M.6910ORCID

Affiliation:

1. Public Health Sciences Division Fred Hutchinson Cancer Center Seattle Washington USA

2. Centre for Clinical Research Kenya Medical Research Insititute Nairobi Kenya

3. Centre for Microbiology Research Kenya Medical Research Insititute Nairobi Kenya

4. Department of Pharmacy University of Washington Seattle Washington USA

5. National AIDS and STI Control Programme Kenya Ministry of Health Nairobi Kenya

6. Department of Global Health University of Washington Seattle Washington USA

7. Department of Obstetrics and Gynecology University of Washington Seattle Washington USA

8. School of Public Health Jomo Kenyatta University of Agriculture and Technology Nairobi Kenya

9. Department of Epidemiology University of Washington Seattle Washington USA

10. Department of Medicine University of Washington Seattle Washington USA

Abstract

AbstractIntroductionThe delivery of daily, oral HIV pre‐exposure prophylaxis (PrEP) at private pharmacies may overcome barriers to PrEP delivery at public healthcare facilities, including HIV‐associated stigma, long wait times and overcrowding.MethodsAt five private, community‐based pharmacies in Kenya, a care pathway for PrEP delivery (ClinicalTrials.gov: NCT04558554) was piloted—the first of its kind in Africa. Pharmacy providers screened clients interested in PrEP for HIV risk, then used a prescribing checklist to identify clients without medical conditions that might contraindicate PrEP safety, counsel them on PrEP use and safety, conduct provider‐assisted HIV self‐testing and dispense PrEP. For complex clinical cases, a remote clinician was available for consultation. Clients who did not meet the checklist criteria were referred to public facilities for free services delivered by clinicians. Pharmacy providers dispensed a 1‐month PrEP supply at initiation and a 3‐month supply thereafter at a client fee of 300 KES (∼$3 USD) per visit.ResultsFrom November 2020 to October 2021, pharmacy providers screened 575 clients, identified 476 who met the prescribing checklist criteria and initiated 287 (60%) on PrEP. Among pharmacy PrEP clients, the median age was 26 years (IQR 22–33) and 57% (163/287) were male. The prevalence of behaviours associated with HIV risk among clients was high; 84% (240/287) reported sexual partners with unknown HIV status and 53% (151/287) reported multiple sexual partners (past 6 months). PrEP continuation among clients was 53% (153/287) at 1 month, 36% (103/287) at 4 months and 21% (51/242) at 7 months. During the pilot observation period, 21% (61/287) of clients stopped and restarted PrEP and overall pill coverage was 40% (IQR 10%–70%). Nearly, all pharmacy PrEP clients (≥96%) agreed or strongly agreed with statements regarding the acceptability and appropriateness of pharmacy‐delivered PrEP services.ConclusionsFindings from this pilot suggest that populations at HIV risk frequently visit private pharmacies and PrEP initiation and continuation at pharmacies is similar to or exceeds that at public healthcare facilities. Private pharmacy‐based PrEP delivery, conducted entirely by private‐sector pharmacy staff, is a promising new delivery model that has the potential to expand PrEP reach in Kenya and similar settings.

Funder

National Institute of Mental Health

Publisher

Wiley

Subject

Infectious Diseases,Public Health, Environmental and Occupational Health

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3