Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study

Abstract

Background While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. Methods: This paper details Kenya’s experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP.Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“…Seventeen articles focused on people at high risk of HIV acquisition without targeting a speci c group [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Yet the description of people at risk of HIV in these records was often based upon differing criteria of eligibility.…”

“…For instance, some records from Western countries (e.g. Canada, Scotland and Belgium) had additional behavioral criteria speci ed for MSM [23,27,38], which were largely absent in records from sub-Saharan Africa [25,28,32,37]. Despite their focus on people at high risk of HIV, eight reports mentioned uptake of PrEP was mainly among MSM [22,25,26,29,[32][33][34][35].…”

“…In high-resource settings, PrEP was more likely to be delivered in such specialised clinics, in particular in USA, Belgium, Scotland, England, Australia, New Zealand and Canada [22,23,24,27,29,31,34,38,40]. In reports from Kenya, Zimbabwe and Table 1 (see end of manuscript) should be positioned here in the main text South Africa, specialised clinics were mentioned as part of the existing facilities used to scale-up the provision of PrEP [25,28,32,37,52]. The policy reports from the latter three African countries were the only identi ed records offering a nation-wide implementation plan for PrEP [25,28,37].…”

“…These often included services for sexual health in general, including PrEP, and targeted TGW, MSM, FSW and youth in particular [49][50][51]54]. In policy reports of Kenya, Zimbabwe and South Africa, CHCs were mentioned as a possible PrEP delivery site tting their decentralisation strategy for the provision of PrEP [25,28,32,37]. The CHCs in these settings focused on identifying people at high risk of HIV living in country regions with a high rate of new HIV diagnoses.…”

“…Four articles mentioned pharmacists as key providers for PrEP services. They described how pharmacies in Kenya had a crucial role in identifying potential PrEP users in the community [25,32]. Two other articles described how pharmacists in the USA delivered all PrEP-related services (eligibility screening, counseling, STI and HIV testing, PrEP dispensing and adherence support) under medical directive.…”