The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

Omollo, Victor; Asewe, Magdaline; Mogere, Peter; Maina, Gakuo; Kuo, Alexandra P.; Odoyo, Josephine; Oware, Kevin; Baeten, Jared M.; Kohler, Pamela; Owens, Tamara; Bukusi, Elizabeth A.; Ngure, Kenneth; Ortblad, Katrina F

doi:10.1097/qai.0000000000003208

Cited by 5 publications

(1 citation statement)

References 35 publications

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“…These models have been shown to improve antiretroviral therapy (ART) adherence and viral suppression [ 11 , 12 , 13 , 14 ]. Currently, community‐based models of differentiated PrEP delivery, such as community pharmacies and mobile clinics, are being tested [ 15 , 16 , 17 , 18 ]. However, the infrastructure to support PrEP services in many African settings largely relies on fixed, government facilities for medication storage, staffing, prescribing, drug accountability, clinical oversight and management of side effects.…”

Section: Introductionmentioning

confidence: 99%

Effect of differentiated direct‐to‐pharmacy PrEP refill visits supported with client HIV self‐testing on clinic visit time and early PrEP continuation

Zewdie,

Ngure,

Mwangi

et al. 2024

J Int AIDS Soc.

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IntroductionDelivery of oral pre‐exposure prophylaxis (PrEP) is being scaled up in Africa, but clinic‐level barriers including lengthy clinic visits may threaten client continuation on PrEP.MethodsBetween January 2020 and January 2022, we conducted a quasi‐experimental evaluation of differentiated direct‐to‐pharmacy PrEP refill visits at four public health HIV clinics in Kenya. Two clinics implemented the intervention package, which included direct‐to‐pharmacy for PrEP refill, client HIV self‐testing (HIVST), client navigator, and pharmacist‐led rapid risk assessment and dispensing. Two other clinics with comparable size and client volume served as contemporaneous controls with the usual clinic flow. PrEP continuation was evaluated by visit attendance and pharmacy refill records, and time and motion studies were conducted to determine time spent in the clinics. Dried blood spots were collected to test for tenofovir‐diphosphate (TFV‐DP) at random visits. We used logistic regression to assess the intervention effect on PrEP continuation and the Wilcoxon rank sum test to assess the effect on clinic time.ResultsOverall, 746 clients were enrolled, 366 at control clinics (76 during pre‐implementation and 290 during implementation phase), and 380 at direct‐to‐pharmacy clinics (116 during pre‐implementation and 264 during implementation phase). Prior to implementation, the intervention and control clinics were comparable on client characteristics (female: 51% vs. 47%; median age: 33 vs. 33 years) and PrEP continuation (35% vs. 37% at 1 month, and 37% vs. 39% at 3 months). The intervention reduced total time spent at the clinic by 35% (median of 51 minutes at control vs. 33 minutes at intervention clinics; p<0.001), while time spent on HIV testing (20 vs. 20 minutes; p = 0.50) and pharmacy (8 vs. 8 minutes; p = 0.8) was unchanged. PrEP continuation was higher at intervention versus the control clinics: 45% versus 33% at month 1, 34% versus 25% at month 3 and 23% versus 16% at month 6. TFV‐DP was detected in 85% (61/72) of samples, similar by the study group (83% vs. 85%).ConclusionsA client‐centred PrEP delivery approach with direct‐to‐pharmacy PrEP refill visits plus client HIVST significantly reduced clinic visit time by more than one‐third and improved PrEP continuation in public health HIV clinics in Kenya.

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Section: Introductionmentioning

confidence: 99%

Effect of differentiated direct‐to‐pharmacy PrEP refill visits supported with client HIV self‐testing on clinic visit time and early PrEP continuation

Zewdie,

Ngure,

Mwangi

et al. 2024

J Int AIDS Soc.

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Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre‐exposure prophylaxis, in an expanding HIV prevention landscape

Verde Hashim,

Llewellyn,

Wood

et al. 2024

J Int AIDS Soc.

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IntroductionThe Dual Prevention Pill (DPP) combines oral pre‐exposure prophylaxis (PrEP) with oral contraception (OC) to prevent HIV and pregnancy. Noting the significant role played by the private sector in delivering family planning (FP) services in countries with high HIV burden, high level of private sector OC uptake, and the recent growth in self‐care and technology‐based private sector channels, we undertook qualitative research in Kenya, South Africa and Zimbabwe to prioritize private sector service delivery approaches for the introduction of the DPP.MethodsBetween March 2022 and February 2023, we conducted a literature review and key informant interviews with 34 donors and implementing partners, 19 government representatives, 17 private sector organizations, 13 pharmacy and drug shop representatives, and 12 telehealth agencies to assess the feasibility of DPP introduction in private sector channels. Channels were analysed thematically based on policies, level of coordination with the public sector, data systems, supply chain, need for subsidy, scalability, sustainability and geographic coverage.ResultsWide geographic reach, ongoing pharmacy‐administered PrEP pilots in Kenya and South Africa, and over‐the‐counter OC availability in Zimbabwe make pharmacies a priority for DPP delivery, in addition to private networked clinics, already trusted for FP and HIV services. In Kenya and South Africa, newer, technology‐based channels such as e‐pharmacies, telehealth and telemedicine are prioritized as they have rapidly grown in popularity due to nationwide accessibility, convenience and privacy. Findings are limited by a lack of standardized data on service uptake in newer channels and gaps in information on commodity pricing and willingness‐to‐pay for all channels.ConclusionsThe private sector provides a significant proportion of FP services in countries with high HIV burden yet is an untapped delivery source for PrEP. Offering users a range of access options for the DPP in non‐traditional channels that minimize stigma, enhance discretion and increase convenience could increase uptake and continuation. Preparing these channels for PrEP provision requires engagement with Ministries of Health and providers and further research on pricing and willingness‐to‐pay. Aligning FP and PrEP delivery to meet the needs of those who want both HIV and pregnancy prevention will facilitate integrated service delivery and eventual DPP rollout, creating a platform for the private sector introduction of multipurpose prevention technologies.

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Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions

Roche,

Were,

Crawford

et al. 2024

Curr HIV/AIDS Rep

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Purpose of Review To provide an overview of the current state of HIV pre-exposure prophylaxis (PrEP) delivery via private sector pharmacies globally, to discuss the context-specific factors that have influenced the design and implementation of different pharmacy-based PrEP delivery models in three example settings, and to identify future research directions. Recent Findings Multiple high- and low-income countries are implementing or pilot testing PrEP delivery via private pharmacies using a variety of delivery models, tailored to the context. Current evidence indicates that pharmacy-based PrEP services are in demand and generally acceptable to clients and pharmacy providers. Additionally, the evidence suggests that with proper training and oversight, pharmacy providers are capable of safely initiating and managing clients on PrEP. The delivery of PrEP services at private pharmacies also achieves similar levels of PrEP initiation and continuation as traditional health clinics, but additionally reach individuals underserved by such clinics (e.g., young men; minorities), making pharmacies well-positioned to increase overall PrEP coverage. Implementation of pharmacy-based PrEP services will look different in each context and depend not only on the state of the private pharmacy sector, but also on the extent to which key needs related to governance, financing, and regulation are addressed. Summary Private pharmacies are a promising delivery channel for PrEP in diverse settings. Countries with robust private pharmacy sectors and populations at HIV risk should focus on aligning key areas related to governance, financing, and regulation that have proven critical to pharmacy-based PrEP delivery while pursuing an ambitious research agenda to generate information for decision-making. Additionally, the nascency of pharmacy-based PrEP delivery in both high- and low-and-middle-income settings presents a prime opportunity for shared learning and innovation.

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The Fidelity of a Pharmacy-Based Oral HIV Pre-Exposure Prophylaxis Delivery Model in Kenya

Cited by 5 publications

References 35 publications

Effect of differentiated direct‐to‐pharmacy PrEP refill visits supported with client HIV self‐testing on clinic visit time and early PrEP continuation

Effect of differentiated direct‐to‐pharmacy PrEP refill visits supported with client HIV self‐testing on clinic visit time and early PrEP continuation

Harnessing private sector strategies for family planning to deliver the Dual Prevention Pill, the first multipurpose prevention technology with pre‐exposure prophylaxis, in an expanding HIV prevention landscape

Getting HIV Pre-exposure Prophylaxis (PrEP) into Private Pharmacies: Global Delivery Models and Research Directions

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