Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

Roche, Stephanie; Wairimu, Winnie N.; Mogere, Peter; Kamolloh, Kevin; Odoyo, Josephine; Kwena, Zachary; Bukusi, Elizabeth A.; Ngure, Kenneth; Baeten, Jared M.; Ortblad, Katrina F

doi:10.1007/s10461-021-03229-5

Cited by 27 publications

(70 citation statements)

References 32 publications

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“…Policymakers and representatives from professional bodies and civil society in Kenya collaboratively developed the pharmacy provider‐led model [ 62 ]. In formative research, Kenyan pharmacy providers and clients anticipated pharmacy‐delivered PrEP services would be feasible and acceptable as long as services were private, respectful, safe and affordable [ 63 ]. PrEP clinicians and pharmacy providers expressed willingness to collaborate to deliver PrEP in pharmacies.…”

Section: Resultsmentioning

confidence: 99%

“…Stakeholders from diverse organizations, including professional bodies and regulatory agencies, perceived private pharmacies as an instrumental component of differentiated HIV service delivery [ 6 , 50 ] and were willing to help collaboratively design and implement models of PrEP service delivery in this setting [ 62 , 69 ]. Additionally, many clients reported a willingness to pay for [ 59 , 61 ] and use these services for increased convenience, autonomy and privacy [ 63 ]. Some limitations of pharmacy‐delivered HIV services included a lack of training and prescribing privileges among pharmacy providers [ 6 , 50 , 62 ] and concerns about HIV status disclosure and quality of care among pharmacy clients [ 53 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

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The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub‐Saharan Africa: a scoping review

et al. 2022

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Introduction: Private pharmacies are an understudied setting for differentiated delivery of HIV services that may address barriers to clinic-delivered services, such as stigma and long wait times. To understand the potential for pharmacy-delivered HIV services in sub-Saharan Africa, we conducted a scoping review of the published and grey literature. Methods: Using a modified Cochrane approach, we searched electronic databases through March 2022 and HIV conference abstracts in the past 5 years for studies that: (1) focused on the delivery of HIV testing, antiretroviral therapy (ART) and/or pre-exposure prophylaxis (PrEP) at private pharmacies in sub-Saharan Africa; (2) reported on effectiveness outcomes (e.g. HIV incidence) or implementation outcomes, specifically feasibility and/or acceptability; and (3) were published in English. Two authors identified studies and extracted data on study setting, population, design, outcomes and findings by HIV service type. Results and discussion: Our search identified 1646 studies. After screening and review, we included 28 studies: seven on HIV testing, nine on ART delivery and 12 on PrEP delivery. Most studies (n = 16) were conducted in East Africa, primarily in Kenya. Only two studies evaluated effectiveness outcomes; the majority (n = 26) reported on feasibility and/or acceptability outcomes. The limited effectiveness data (n = 2 randomized trials) suggest that pharmacy-delivered HIV services can increase demand and result in comparable clinical outcomes (e.g. viral load suppression) to standard-of-care clinic-based models. Studies assessing implementation outcomes found actual and hypothetical models of pharmacy-delivered HIV services to be largely feasible (e.g. high initiation and continuation) and acceptable (e.g. preferable to facility-based models and high willingness to pay/provide) among stakeholders, providers and clients. Potential barriers to implementation included a lack of pharmacy provider training on HIV service delivery, costs to clients and providers, and perceived low quality of care. Conclusions: The current evidence suggests that pharmacy-delivered HIV services may be feasible to implement and acceptable to clients and providers in parts of sub-Saharan Africa. However, limited evidence outside East Africa exists, as does limited evidence on the effectiveness of and costs associated with pharmacy-delivered HIV services. More research of this nature is needed to inform the scale-up of this new differentiated service delivery model throughout the region.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub‐Saharan Africa: a scoping review

et al. 2022

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“…While the success of DSD models hinges on continued process evaluations to understand clients' needs, preferences, and behaviours [2,14], the reported health outcomes have been mostly linked to the factors related to the health systems organization. The studies that attempted to seek clients' perspectives on DSD models targeted the general population of PLWHIV [14,15], and one study mainly focused on clients' acceptability of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis [16]. FSWs have unique challenges with increased risk to HIV acquisition, and therefore assessing their perspectives on how DSD models influence FSWs' individual and population-level utilization of services is critical.…”

Section: Introductionmentioning

confidence: 99%

“My condition is my secret”: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

Atuhaire

Shumba

Nyasulu

2022

BMC Health Serv Res

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Background Differentiated service delivery (DSD) models for female sex workers (FSWs) continue to be scaled up with the goal of expanding access to HIV services and treatment continuity. However, little is known about FSWs’ perspectives on their preferences, facilitators, and barriers to the effective utilization of various DSD models. Methods We conducted 24 in-depth interviews among FSWs on antiretroviral therapy for at least one year in two drop-in centres and two public health facilities in Kampala, Uganda in January 2021. Results The facility-based individual management model was most preferred, due to a wide array of comprehensive health services, privacy, and professional health workers. Community DSD models were physically accessible, but least preferred due to stigmatization and discrimination, lack of privacy and confidentiality, and limited health services offered. Conclusion Targeted strategies to reduce stigma and discrimination and the provision of high-quality services have potential to optimise FSWs’ access to HIV services.

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“…We also acknowledge that this is a new and rapidly growing field; we may have excluded articles which would have met our inclusion criteria but were published after our search date, including at least one acceptability and feasibility study conducted among clients and health workers in Kenya which reinforced our findings of support for expanding PrEP to retail pharmacies, although participants wanted to ensure that such services would be ‘private, respectful, safe and affordable’. 47 Our conclusions are also limited because nearly all the evidence identified in our review came from the USA, except for a few studies from Kenya and South Africa. Future research should continue to examine the potential for pharmacy provision of PrEP in resource-limited settings.…”

Section: Discussionmentioning

confidence: 84%

PrEP distribution in pharmacies: a systematic review

et al. 2022

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IntroductionNovel mechanisms of service delivery are needed to expand access to pre-exposure prophylaxis (PrEP) for HIV prevention. Providing PrEP directly through pharmacies could offer an additional option for reaching potential users.MethodsWe conducted a systematic review of studies examining effectiveness, values and preferences of end users and health workers, and cost of PrEP initiation and continuation through pharmacies (pharmacy access). We searched PubMed, CINAHL, LILACS and EMBASE through 2 December 2020. We also searched clinical trial registries and recent HIV conference abstracts. Standardised methods were used to search, screen and extract data from included studies.ResultsNo studies met the inclusion criteria for the effectiveness review, for either PrEP initiation or continuation. However, six ‘case studies’ presenting non-comparative data from PrEP pharmacy programmes demonstrated feasibility of this model in the USA. Eleven studies reported values and preferences of end users and health workers. In the USA, Kenya and South Africa, potential PrEP clients generally supported pharmacy access, although some preferred clinics. One study of PrEP pharmacy clients found all would ‘definitely recommend’ the programme. Six studies found pharmacists were generally supportive of offering PrEP; one study including doctors found more limited favour, while one study of diverse Kenyan stakeholders found broad support. Three studies reported cost data indicating client willingness to pay in the USA and Kenya and initial sustainability of a clinic financial model in the USA.ConclusionProvision of PrEP through pharmacies has been demonstrated to be feasible in the USA and acceptable to potential end users and stakeholders in multiple settings. Limited evidence on effectiveness and requirements for laboratory testing and assurance of high-quality services may limit enthusiasm for this approach. Further research is needed to determine if pharmacy access is a safe and effective way to help achieve global HIV prevention goals.PROSPERO registration numberCRD42021231650.

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Acceptability and Feasibility of Pharmacy-Based Delivery of Pre-Exposure Prophylaxis in Kenya: A Qualitative Study of Client and Provider Perspectives

Cited by 27 publications

References 32 publications

The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub‐Saharan Africa: a scoping review

The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub‐Saharan Africa: a scoping review

“My condition is my secret”: perspectives of HIV positive female sex workers on differentiated service delivery models in Kampala Uganda

PrEP distribution in pharmacies: a systematic review

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