Test and Prevent: Evaluation of a Pilot Program Linking Clients With Negative HIV Test Results to Pre-exposure Prophylaxis in Zimbabwe

Stankevitz, Kayla; Nhamo, Definate; Murungu, Joseph; Ridgeway, Kathleen; Mamvuto, Takudzwa; Lenzi, Rachel; Lydon, Megan; Katsande, Naledi; Mahaka, Imelda; Hoke, Theresa

doi:10.9745/ghsp-d-20-00444

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…Their emphasis on how the OSS made their clients happy suggests that clinicians were motivated, in part, by positive client feedback. This finding aligns with other qualitative studies with PrEP providers [51,52], as well as theories from behavioural and implementation science, which posit that provider willingness to adopt an innovation is driven, in part, by feelings of purpose [53] and belief that the innovation will confer a relative advantage [54]. Providers may also have been motivated to change their delivery practices because of the efficiency gains it created for them (e.g., less room‐to‐room movement), which freed up time for them to spend with other clients.…”

Section: Discussionsupporting

confidence: 83%

A one‐stop shop model for improved efficiency of pre‐exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study

et al. 2021

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Introduction In public clinics in Kenya, separate, sequential delivery of the component services of pre‐exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients’ ability and desire to access and continue PrEP. We conducted a mixed methods study in four public clinics in western Kenya to identify strategies for operationalizing a one‐stop shop (OSS) model and evaluate whether this model could improve client wait time and care acceptability among clients and providers without negatively impacting uptake or continuation. Methods From January 2020 through November 2020, we collected and analysed 47 time‐and‐motion observations using Mann–Whitney U tests, 29 provider and client interviews, 68 technical assistance reports, and clinic flow maps from intervention clinics. We used controlled interrupted time series (cITS) to compare trends in PrEP initiation and on‐time returns from a 12‐month pre‐intervention period (January–December 2019) to an 8‐month post‐period (January–November 2020, excluding a 3‐month COVID‐19 wash‐out period) at intervention and control clinics. Results From the pre‐ to post‐period, median client wait time at intervention clinics dropped significantly from 31 to 6 minutes (p = 0.02), while median provider contact time remained around 23 minutes (p = 0.4). Intervention clinics achieved efficiency gains by moving PrEP delivery to lower volume departments, moving steps closer together (e.g. relocating supplies; cross‐training and task‐shifting), and differentiating clients based on the subset of services needed. Clients and providers found the OSS model highly acceptable and additionally identified increased privacy, reduced stigma, and higher quality client–provider interactions as benefits of the model. From the pre‐ to post‐period, average monthly initiations at intervention and control clinics increased by 6 and 2.3, respectively, and percent of expected follow‐up visits occurring on time decreased by 18% and 26%, respectively; cITS analysis of PrEP initiations (n = 1227) and follow‐up visits (n = 2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on‐time returns (all p>0.05). Conclusions An OSS model significantly improved client wait time and care acceptability without negatively impacting initiations or continuations, thus highlighting opportunities to improve the efficiency of PrEP delivery efficiency and client‐centredness.

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Section: Discussionsupporting

confidence: 83%

A one‐stop shop model for improved efficiency of pre‐exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study

et al. 2021

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“…These tools, however, may be screening out those who are most vulnerable, due to their lack of awareness or their discomfort with disclosing risk factors [ 21 , 22 ]. Some health care workers (HCWs) also feel uncomfortable asking the sensitive questions included in risk assessments, resulting in fewer potential clients screened for or offered oral PrEP [ 23 ]. Application of stringent risk assessment tools can further stigmatize oral PrEP and the individuals accessing it [ 5 ].…”

Section: Broad Eligibility Criteriamentioning

confidence: 99%

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Bhavaraju¹,

Shears²,

Schwartz

et al. 2021

Curr HIV/AIDS Rep

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Purpose of review Clinical trials have found that the dapivirine vaginal ring (DVR) is safe to use and effective at reducing women’s risk of acquiring HIV infection. As countries prepare for the introduction of this novel long-acting, woman-controlled prevention method, an examination of key learnings from oral pre-exposure prophylaxis (PrEP) delivery will help programs leverage successful innovations and approaches to support DVR scale-up and expand the method mix for HIV prevention. Recent findings Intensive efforts over the past 5 years have yielded lessons on how to facilitate access to oral PrEP; expand service delivery for PrEP; address the knowledge, attitudes, and skills providers need to support PrEP initiation and effective use; develop messaging that builds community and partner support and combats stigma; and understand the cyclical nature of PrEP use. Summary Evidence from oral PrEP introduction and scale-up can help inform and expedite DVR introduction.

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“…Zimbabwean authorities recognize that HIV infection is a public health issue that affects the LGBT community and straight men and women. When analyzing the possible causes for the lack of PrEP, studies show that it is primarily a lack of information; doctors did not refer to the high-risk population [24].…”

Section: Review Results/discussionmentioning

confidence: 99%

HIV Pre-exposure Prophylaxis in the LGBTQ Community: A Review of Practice and Places

Dorcé-Medard¹,

Okobi²,

Grieb³

et al. 2021

Cureus

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Test and Prevent: Evaluation of a Pilot Program Linking Clients With Negative HIV Test Results to Pre-exposure Prophylaxis in Zimbabwe

Cited by 7 publications

References 29 publications

A one‐stop shop model for improved efficiency of pre‐exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study

A one‐stop shop model for improved efficiency of pre‐exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study

Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

HIV Pre-exposure Prophylaxis in the LGBTQ Community: A Review of Practice and Places

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