Abstract
BackgroundAs pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples.MethodsThe 20 consultation participants represented the Ministry of Health, faith- and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing.ResultsThe barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community- and population-level barriers included topic-specific education within the populations and community, involvement of partners and family members, mass HIV testing, and peer educators. Barriers to PrEP uptake included non-adherence to pill taking and missing clinic visits. For drug adherence, facilitators were counselling and involving family members. Discussants suggested that client reminders, e.g., home visits, were needed to encourage clients to keep their clinic appointments.ConclusionsStrategies for encouraging eligibility screening and ongoing HIV testing will have local and population-specific aspects. Our results nonetheless apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations.
Highlights
As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important
Our results apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations
Our aim was to answer the following research question: What are some locally grounded approaches to future rollout of oral PrEP to local populations at risk of HIV infection, if clinical trials show the method to be effective? based on lessons learned from the provision of HIV-prevention interventions, what might be some of the barriers, solutions, and facilitators related to the clinical screening of potential clients for eligibility to take oral PrEP, and to ongoing HIV testing for PrEP users in four local target populations? The results reported here are intended to inform the design of future programs geared toward the four target populations in Kenya, as well as other similar populations in the sub-Saharan African region
Summary
As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. Guidance on PrEP implementation for the antiretroviral drug Truvada (emtricitabine and tenofovir disoproxil fumarate, or FTC/TDF) is becoming available, beginning with clinical recommendations from the U.S Centers for Disease Control and Prevention (CDC) for the U.S context [1,2,3] and from the World Health Organization (WHO) for a global audience [4]. These recommendations for clinicians address client eligibility, the prescribing of FTC/TDF as PrEP, testing schedules for HIV infection and liver and renal function, follow-up schedules for provider visits and pill refills, and considerations for discontinuing PrEP. Such locally developed strategies must build on the knowledge and experience gained from current and past interventions with the target populations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
