Abstract
Sexually active African women are a priority population for HIV prevention due to the disproportionately high frequency of new HIV infections. Family planning (FP) clinics offer an already trusted platform that can be used to reach women for HIV prevention services, including pre-exposure prophylaxis (PrEP). In the recent PrEP Implementation in Young Women and Adolescent (PrIYA program), we piloted PrEP implementation in FP clinics in Kisumu, Kenya, and demonstrated that it was possible to integrate PrEP provision in FP systems with a program-dedicated staff. In this perspective, we describe experiences and strategies employed to introduce PrEP implementation in FP clinics and lessons learned. We identified the following lessons for PrEP introduction in FP clinics in Kenya: (1) possible to integrate and generate high enthusiasm for PrEP delivery in FP clinics but persistence on PrEP is a challenge, (2) involvement of national and regional stakeholders is critical for buy-in, contextualization, and sustainability, (3) delivery models that do not integrate fully with existing staff and systems are less sustainable, (4) creatinine testing at PrEP initiation may not be necessary, (5) fully integrated HIV and FP data systems need to be developed, and (6) incorporating implementation science evaluation is important to understand and document effective implementation strategies. In summary, integration of HIV prevention and FP services provides an opportunity to promote one-stop women-centered care efficiently. However, a broader focus on delivery models that utilize existing staff and novel strategies to help women identify their own risk for HIV are needed to ensure greater success and sustainability.
Highlights
In HIV high burden settings, many women concerned about avoiding or postponing pregnancy are at elevated risk for HIV
We describe how we approached the introduction of pre-exposure prophylaxis (PrEP) implementation in family planning (FP) clinics and lessons learned to facilitate dissemination of these learnings in other low-income settings
To supplement our published quantitative analysis, we describe our experiences and lessons learned that are organized under 10 themes: (1) Data collection and systems; (2) Demand creation, initiation, and continuation; (3) Service delivery models; (4) Stakeholder engagement and facility preparation; (5) Training and capacity strengthening for PrEP implementation; (6) PrEP commodity supply chain; (7) PrEP laboratories; (8) New clients to FP clinics; (9) Consent for programmatic and research activities; and (10) Importance of integrating rigorous implementation science evaluation
Summary
In HIV high burden settings, many women concerned about avoiding or postponing pregnancy are at elevated risk for HIV. The sources included: abstraction of program data, technical assistant reports, debrief reports from clinical training and stakeholder engagement, and observations In this narrative, to supplement our published quantitative analysis, we describe our experiences and lessons learned that are organized under 10 themes: (1) Data collection and systems; (2) Demand creation, initiation, and continuation; (3) Service delivery models; (4) Stakeholder engagement and facility preparation; (5) Training and capacity strengthening for PrEP implementation; (6) PrEP commodity supply chain; (7) PrEP laboratories; (8) New clients to FP clinics; (9) Consent for programmatic and research activities; and (10) Importance of integrating rigorous implementation science evaluation. Triangulation of multiple data sources permitted the project to document and learn important lessons to the extent possible about working in public health FP clinics in this setting
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