A modified pharmacy provider-led delivery model of oral HIV pre- and post-exposure prophylaxis in Kenya: a pilot study extension

Abstract

Introduction: Private pharmacies in Africa reach individuals with ongoing and periodic HIV risk, yet few countries currently leverage pharmacies as an HIV service delivery platform. We conducted a 6-month pilot to evaluate a model for pharmacy provider-led delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) in Kenya.

Methods: At 12 private pharmacies in Kisumu and Kiambu Counties, licensed pharmacy providers initiated and managed eligible clients ≥18 years on PrEP and PEP under remote clinician supervision (NCT04558554); four of these pharmacies additionally offered sextually transmitted infection (STI) testing. PrEP/PEP clients were scheduled for follow-up 1 month later and then quarterly (PrEP clients only). Primary outcomes included PrEP and PEP initiation and continuation during the pilot period. Client and providers rated the model across multiple constructs of acceptability and feasibility from established frameworks.

Results: From January to July 2022, 1028 clients interested in PrEP, PEP and/or STI testing were screened and 829 initiated one or more service: 661 PrEP, 162 PEP and 52 STI testing. About half of clients (48%, 398/829) were male, most were unmarried (78%, 644/829) and PrEP-naïve (89%, 737/829), and the median age was 25 years (IQR 22-31). Most PrEP clients reported inconsistent condom use (88%, 581/661) or sex with partners of unknown HIV status (70%, 460/661) in the past 6 months. Most PEP clients reported condomless sex (48%, 78/162) or a condom break (46%, 75/162) in the past 72 hours; 4% (6/162) reported sexual assault. Among PrEP clients eligible for a refill, 73% (479/658) refilled at least once and 60% (197/328) twice. Among PEP clients eligible for follow-up, 44% (65/148) completed follow-up HIV testing and 20% (30/148) transitioned to PrEP. Among STI clients, 19% (10/52) tested positive for gonorrhoea (n = 7) and/or chlamydia (n = 5). Most clients and providers (≥92%) found the delivery model and its implementation strategies acceptable. All providers (n = 12) thought it was possible to deliver PrEP and PEP at pharmacies in Kenya.

Conclusions: Pharmacy PrEP/PEP delivery achieved high uptake, continuation and acceptability among eligible clients that could benefit, highlighting the potential of pharmacies to expand HIV prevention service coverage in Kenya, particularly to individuals not accessing these services at clinics.

Keywords: HIV prevention; Kenya; differentiated service delivery; post‐exposure prophylaxis; pre‐exposure prophylaxis; private pharmacies.

Figure 1

Participant flow chart. Abbreviations: PEP, post‐exposure prophylaxis; PrEP, pre‐exposure prophylaxis; STI, sexually transmitted infections. ¹STI testing offered at four study pharmacies; clients seeking STI testing were given the option to screen for PrEP/PEP eligibility; ²Self‐identified as a person living with HIV (PLHIV); ³Self‐reported behaviors in past 6 months; ⁴Self‐reported a high‐risk exposure in past 72 hours.

Figure 2

Continuation of pharmacy PrEP services over the pilot duration. PrEP continuation among (a) all PrEP clients; (b) male PrEP clients <25 years old and >25 years old; and (b) female PrEP clients <25 years old and >25 years old. Abbreviation: PrEP, pre‐exposure prophylaxis.

Figure 3

Completion of HIV testing at PEP follow‐up visit and PEP to PrEP transition over the pilot duration. Completion of HIV testing at pharmacy‐based follow‐up visit and PEP‐to‐PrEP transition among (a) all PEP clients; (b) male PEP clients <25 years old and >25 years old; and (b) female PEP clients <25 years old and >25 years old. Abbreviations: PEP, post‐exposure prophylaxis; PrEP, pre‐exposure prophylaxis.