Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultation

Abstract

Introduction In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya. Methods In January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions. Results Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting. Conclusions PrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings.

Integration of HIV and sexual and reproductive health in the era of anti-retroviral-based prevention: findings from assessments in Kenya, Malawi and Zimbabwe

“…186 A recent stakeholder consultation in Kenya showed that providers and implementers were strongly supportive of developing and testing a model for pharmacy-based oral PrEP delivery to increase oral PrEP access. 187 The consultative group developed a pathway for pilot testing pharmacy-based oral PrEP delivery in Kenya. Expanding PrEP delivery beyond health clinics and aligning FP and HIV prevention delivery channels has the potential to increase uptake of both PrEP and contraception, and respond to women's desire for convenient and less stigmatized services.…”

Level and determinants of willingness to pay for rapid COVID-19 testing delivered through private retail pharmacies in Kenya

“…Recent evidence points to a decline in the utilisation of inpatient and outpatient services in Kenya [15]; pharmacies could be absorbing some of this patient traffic. Pharmacies in Kenya have been involved in the delivery of several health interventions, such as malaria rapid testing, HIV self-testing, and other disease screening services [16][17][18][19][20]. Consequently, private retail pharmacies can be used to deliver COVID-19 rapid testing services, hence expanding testing coverage and access to affordable and timely testing.…”

Design and evaluation of strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings in western Kenya: a mixed-methods study protocol

“…We will begin by identifying potential attributes and levels from preliminary qualitative data and the literature. 22 We will conduct up to five focus group discussions (FGDs) with women (n=5-10) and five FGDs with health providers (n=5-10 community health workers and nurses), and five semi-structured interviews with decision-makers to further refine and identify additional attributes. We primarily want to assess whether women would consider going to a pharmacy instead of an antenatal care clinic during pregnancy for HIV prevention products or services.…”

“…We will leverage ongoing studies to identify potential community pharmacies for inclusion in the study. 22 Study design and data collection Qualitative data will be collected through individual interviews using an interview guide based on TDF constructs. As ascertained in prior studies, we will assess select constructs from the TDF based on their likely influence on implementation.…”

“…The proposed study will leverage expertise and resources from several ongoing PrEP implementation studies in antenatal care and pharmacy settings. 22 24 The studies Open access have and stakeholder advisory boards that will provide opportunities to share study queries and findings with community members, leaders and decisionmakers. In June 2019, we shared preliminary research objectives with the community advisory board members and obtained their input on the feasibility of leveraging community pharmacies to identify pregnant women who are at risk for HIV acquisition and can benefit from PrEP.…”