Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

Stephanie D Roche,Katrina F Ortblad,Jared M Baeten,Zachary A Kwena,Peter Mogere,Kevin Kamolloh,Elizabeth A Bukusi,Kenneth Ngure,Njeri Wairimu,Josephine Odoyo

doi:10.1007/s10461-021-03229-5

Abstract

As countries scale up pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models are needed to expand access to populations at HIV risk that are unwilling or unable to access clinic-based PrEP care. To identify factors that may influence implementation of retail pharmacy-based PrEP delivery in Kenya, we conducted in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from two provinces. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., staffing levels, documentation requirements). Future research is needed to develop and test tailored packages of implementation strategies that are most effective at integrating PrEP delivery into routine pharmacy practice in Kenya and other high HIV prevalence settings.

Highlights

MethodsIn the nearly 10 years since clinical trials confirmed the safety and efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models have been implemented around the world, primarily in high-income settings [1, 2]
Even in Kenya, which has the second highest number of PrEP users in the world, findings from open label, demonstration, and implementation projects have found that client desire for public clinic-based PrEP delivery is tempered by concerns about stigma, opportunity costs, and limited privacy [7,8,9,10]
We interviewed 82 individuals: 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers (Table 1)

Summary

Introduction

In the nearly 10 years since clinical trials confirmed the safety and efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models have been implemented around the world, primarily in high-income settings [1, 2]. Even in Kenya, which has the second highest number of PrEP users in the world, findings from open label, demonstration, and implementation projects have found that client desire for public clinic-based PrEP delivery is tempered by concerns about stigma, opportunity costs, and limited privacy [7,8,9,10]. In 2017, the Kenyan Ministry of Health (MOH) released a 5-year plan for increasing access to PrEP [12], which includes scaling up PrEP delivery to additional public HIV clinics and scaling out PrEP delivery to other venues [13], including retail pharmacies. Jackson, and Omaha) [5, 19,20,21,22,23,24]

Objectives

Methods

Discussion

Conclusion