Online HIV prophylaxis delivery: Protocol for the ePrEP Kenya pilot study

Abstract

BackgroundOnline pharmacies in Kenya provide sexual and reproductive health products (e.g., HIV self-testing, contraception) and could be leveraged to increase the reach of HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP) to populations who do not frequently attend health facilities. To date, evidence is limited for operationalizing online PrEP/PEP delivery and the type of populations reached with this differential service delivery model.MethodsThe ePrEP Kenya Pilot will deliver daily oral PrEP and PEP via MYDAWA, a private online pharmacy retailer, to clients in Nairobi for 18 months. Potential clients will obtain information about PrEP/PEP on MYDAWA's sexual wellness page and self-screen for HIV risk. Individuals ≥18 years, identified as at HIV risk, and willing to pay for a blood-based HIV self-test and PrEP/PEP delivery will be eligible for enrollment. To continue with online PrEP/PEP initiation, eligible clients will purchase a blood-based HIV self-test for 250 KES (~USD 2) [delivered to their setting of choice for 99 KES (~USD 1)], upload an image of their self-test result, and attend a telemedicine visit with a MYDAWA provider. During the telemedicine visit, providers will screen clients for PrEP/PEP eligibility, including clinical concerns (e.g., kidney disease), discuss self-test results, and complete counseling on PrEP/PEP use and safety. Providers will refer clients who self-test HIV positive or report any existing medical conditions to the appropriate services at healthcare facilities that meet their preferences. Eligible clients will be prescribed PrEP (30-day PrEP supply at initiation; 90-day PrEP supply at follow-up visits) or PEP (28-day supply) for free and have it delivered for 99 KES (~USD 1). We will measure PrEP and PEP initiation among eligible clients, PEP-to-PrEP transition, PrEP continuation, and implementation outcomes (e.g., feasibility, acceptability, and costs).DiscussionEstablishing pathways to increase PrEP and PEP access is crucial to help curb new HIV infections in settings with high HIV prevalence. The findings from this study will provide evidence on the implementation of online pharmacy PrEP and PEP service delivery that can help inform guidelines in Kenya and similar settings.

“What if I get sick, where shall I go?”: a qualitative investigation of healthcare engagement among young gay and bisexual men in Nairobi, Kenya

“…Previous research has demonstrated the usefulness of digital interventions in addressing various health challenges such as HIV/STIs [ 57 – 59 ], mental health [ 60 ] and substance use [ 61 ] among YMSM, as well as accessing social support in coming out and finding a community to belong to [ 62 ]. An ongoing study in Kenya is assessing acceptability, feasibility and cost implications of online PrEP and PEP delivery among a diverse clientele within the Nairobi metropolis [ 63 ]. We suggest that digital interventions should be considered for service delivery among YMSM in Kenya, given the demonstrated potential usefulness of such interventions [ 64 ], and the ubiquitous use of smart phones in this population.…”

Potential cost-effectiveness of community availability of tenofovir, lamivudine, and dolutegravir for HIV prevention and treatment in east, central, southern, and west Africa: a modelling analysis

“…Although innovative approaches to the community delivery of self-testing kits for HIV and ART, oral PrEP, and PEP have been and are being studied, [10][11][12][13][14] the unrestricted access that we propose has not, to our knowledge, been implemented in any region of east, central, southern, and west Africa. Pilot implementation studies with process evaluation would be needed before a full implementation is made, to enable an understanding of the contexts in which community TLD is adopted as local policy, made available widely and discreetly, and used by community members.…”

Measuring the performance of HIV self‐testing at private pharmacies in Kenya: a cross‐sectional study

“…HIVST may help overcome some of these challenges by enabling community-based PrEP delivery models outside clinic settings (e.g. online delivery [13] and pharmacy delivery [14]) and increasing efficiencies within clinic-based PrEP delivery models (e.g. testing while waiting [15] and multi-month dispensing supported with interim HIVST [16]).…”