Implementation determinants and strategies in integration of PrEP into maternal and child health and family planning services: experiences of frontline healthcare workers in Kenya

Frontiers in Reproductive Health

Reproductive Health

Jillian Pintye¹  Jillian Neary²  Julia C. Dettinger³  Gabrielle O’Malley³  Kristin Beima-Sofie³  Anjuli D. Wagner³  Pamela Kohler⁴  Grace John-Stewart⁵  Bryan J. Weiner⁶  John Kinuthia⁷  Harison Lagat⁷  Felix Abuna⁷  Winnie Owade⁸  Mercy Awuor⁸ 

[1] Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States;Department of Epidemiology, University of Washington, Seattle, WA, United States;Department of Global Health, University of Washington, Seattle, WA, United States;Department of Global Health, University of Washington, Seattle, WA, United States;Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, United States;Department of Global Health, University of Washington, Seattle, WA, United States;Department of Epidemiology, University of Washington, Seattle, WA, United States;Departments of Pediatrics and Medicine, University of Washington, Seattle, WA, United States;Department of Global Health, University of Washington, Seattle, WA, United States;Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States;Research & Programs, Kenyatta National Hospital, Nairobi, Kenya;UW-Kenya, Nairobi, Kenya;

关键词: pre-exposure prophylaxis (PrEP);    pregnancy;    postpartum;    adolescent girls and young women (AGYW);    implementation science;    consolidated framework for implementation research (CFIR);    implementation strategies;   

DOI  :  10.3389/frph.2023.1205925

 received in 2023-04-14, accepted in 2023-09-04,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDelivery of PrEP to adolescent girls and young women (AGYW) and to pregnant women through maternal and child health (MCH) and family planning (FP) clinics is scaling up in Kenya. Evaluation of implementation challenges and strategies is critical to optimize delivery.MethodsWe conducted focus group discussions (FGDs) with healthcare workers (HCWs) in MCH and FP clinics offering PrEP in a large implementation project in Kisumu, Kenya. Discussion guides were based on the Consolidated Framework for Implementation Research (CFIR). FGDs were audio recorded and transcribed. Directed content analysis was used to identify implementation challenges and strategies to overcome them.ResultsFifty HCWs from 26 facilities participated in 8 FGDs. HCWs believed PrEP integration was appropriate because it met the needs of AGYW and pregnant women by providing a female-controlled prevention strategy and aligned with policy priorities of elimination of vertical HIV transmission. They were universally accepting of PrEP provision, especially through MCH clinics, noting the relative advantage of this approach because it: (1) enabled high coverage, (2) harmonized PrEP and MCH visits, and (3) minimized stigma compared to PrEP offered through HIV care clinics. However, HCWs noted implementation challenges affecting feasibility and adoption including: (1) increased workload and documentation burden amid workforce shortages, (2) insufficient health care worker knowledge (3) multiple implementing partners with competing priorities (4) drug and documentation form stockouts. HCWs employed various implementation strategies to overcome challenges, including task shifting from nurses to HIV testing providers, patient flow modifications (e.g., fast-tracking PrEP clients to reduce wait times), PrEP demand generation and myth clarification during health talks, provider education, dedicated PrEP delivery rooms, and coordination with adolescent-friendly services. Additional suggested strategies to improve PrEP integration included community education to increase broader PrEP awareness and enable shorter counseling sessions, and task-shifting data entry and client risk assessments.ConclusionsHCWs were enthusiastic about the appropriateness and acceptability of integrating PrEP services into MCH and FP clinics but noted challenges to adoption and feasibility. Strategies to address challenges focused on improving provider time and space constraints, and increasing provider and client knowledge.

【 授权许可】

Unknown   
© 2023 Wagner, Beima-Sofie, Awuor, Owade, Neary, Dettinger, Pintye, Abuna, Lagat, Weiner, Kohler, Kinuthia, John-Stewart and O’Malley.