Brief Report: Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya

Abstract

Background: Programmatic approaches for delivering PrEP to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics. Methods: Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya to determine optimal clinic flow for PrEP integration into antenatal (ANC) and postnatal (PNC) care. A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically-eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys. Results: Clinics developed two approaches for integrating PrEP delivery within ANC/PNC: 1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or 2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (IQR 15–26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (IQR 7–15) was spent on PrEP-related risk assessment and counseling. Conclusions: PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing.

The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

“… All PrEP care provided through nurse practitioners after having received a PrEP training course. Oral PrEP provided through in-person visits 20 Pintye et al, 2018 [ 41 ] Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya Pilot Implementation Study Kisumu, Kenya Oral PrEP provided in a research setting through a public or private sector antenatal or postnatal care clinic. All PrEP-specific services provided by nurses within the ANC/PNC clinic.…”

“…Five articles had a focus on the combination of MSM and TGW [ 23 – 25 , 34 , 46 ]. One study focused exclusively on TGW [ 32 ], one on female sex workers (FSW) [ 33 ], one on men and women in a serodiscordant relationship [ 35 ], one on pregnant or postpartum women [ 41 ] and one study focused exclusively on youth (11–24 years old) at risk of HIV acquisition [ 40 ]. See Fig.…”

“…In one article, PrEP services were provided in a hospital setting by integrating PrEP in reproductive health services provided to pregnant and postpartum women in Kenya [ 41 ]. Lastly, sometimes PrEP was delivered as part of a study setting, with the clinical site of PrEP provision being referred to as ‘study centres’ [ 22 – 25 ].…”

Two-Way Short Message Service (SMS) Communication May Increase Pre-Exposure Prophylaxis Continuation and Adherence Among Pregnant and Postpartum Women in Kenya

“…( approximately 18 minutes per client. 25 Women who initiated PrEP received this standardized counseling from nurses who were experienced with PrEP delivery, yet clarifications and concerns about the PrEP use and how PrEP works accounted for more than half (56%) of all unprompted issues raised by the participants. This indicated that many women who initiated PrEP left the clinic with concerns about PrEP use or that PrEP concerns may have arisen after they left the clinic that would otherwise go unaddressed without access to a remote nurse.…”

“…In the PrIYA Program, 40 program-supported nurses were trained on PrEP delivery per national guidelines as previously described. 25 Briefly, nurses screened women who did not have HIV for behavioral risk factors, including male partner HIV status and willingness to consider PrEP. Behavioral risk factors were assessed using a standardized risk assessment tool.…”