Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultation

BMC Health Services Research

Josephine Odoyo¹  Kevin Kamolloh¹  Stephanie Roche²  Katrina F. Ortblad²  Elizabeth Bukusi³  Jared M. Baeten⁴  Elizabeth Irungu⁵  Jillian Pintye⁶  Peter Mogere⁷  Kenneth Ngure⁸  Nelly R. Mugo⁹ 

[1] Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya;Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, 98104, Seattle, WA, USA;Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, 98104, Seattle, WA, USA;Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya;Department of Obstetrics and Gynecology, University of Washington, Seattle, USA;Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, 98104, Seattle, WA, USA;Department of Epidemiology, University of Washington, Seattle, USA;Department of Medicine, University of Washington, Seattle, USA;Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, 98104, Seattle, WA, USA;Partners in Health and Research Development, Thika, Kenya;Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, 98104, Seattle, WA, USA;School of Nursing, University of Washington, Seattle, USA;Partners in Health and Research Development, Thika, Kenya;Partners in Health and Research Development, Thika, Kenya;Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya;Partners in Health and Research Development, Thika, Kenya;Sexual Reproductive and Adolescent Child Health Research Program, Kenya Medical Research Institute, Nairobi, Kenya;

关键词: PrEP;    HIV prevention;    Pharmacy care;    Kenya;    Stakeholders;    Implementation science;   

DOI  :  10.1186/s12913-020-05898-9

来源: Springer

【 摘 要 】

IntroductionIn Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya.MethodsIn January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions.ResultsStakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting.ConclusionsPrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings.

【 授权许可】

CC BY