Scale up of PrEP integrated in public health HIV care clinics: a protocol for a stepped-wedge cluster-randomized rollout in Kenya

Mugwanya, Kenneth; Irungu, Elizabeth; Bukusi, Elizabeth A.; Mugo, Nelly; Odoyo, Josephine; Wamoni, Elizabeth; Ngure, Kenneth; Morton, Jennifer; Peebles, Kathryn; Masyuko, Sarah; Barnabee, Gena; Donnell, Deborah; Barnabas, Ruanne V.; Haberer, Jessica; O’Malley, Gabrielle; Baeten, Jared M.

doi:10.1186/s13012-018-0809-7

Cited by 26 publications

(27 citation statements)

References 33 publications

(37 reference statements)

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“…From February 2017 to April 2019, we conducted individual interviews with HIV‐negative women and men who were members of heterosexual HIV serodiscordant couples and health providers as part of the Partners Scale‐Up Project. The Partners Scale‐Up Project is evaluating PrEP delivery integrated into 30 public HIV clinics in Central (twelve clinics), Western (twelve clinics) and Coastal Kenya (six clinics) . In Kenya, PrEP is recommended for HIV‐negative partners until HIV‐positive partners initiate and sustain ART use for at least six months .…”

Section: Methodsmentioning

confidence: 99%

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

et al. 2020

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Introduction Sustained HIV viral suppression resulting from antiretroviral therapy (ART) eliminates the risk of HIV transmission, a concept popularly framed as Undetectable = Untransmittable (U = U). We explored knowledge and acceptance of information around the elimination of HIV transmission risk with ART (U = U) in Kenya. Methods Our qualitative study was conducted within a project evaluating the use of pre‐exposure prophylaxis (PrEP) integrated into ART care for HIV serodiscordant couples in public clinics in Kenya (the Partners Scale Up Project). From February 2017 to April 2019, we conducted semi‐structured key informant interviews with 83 health providers and in‐depth interviews with 61 HIV‐negative people in serodiscordant relationships receiving PrEP services. Transcripts were coded using thematic analysis. Results Health providers reported being aware of reduced risk of HIV transmission as a result of consistent ART use and used words such as “very low,” “minimal” and “like zero” to describe HIV transmission risk after viral suppression. Providers reported finding viral load results helpful when counselling clients about the risk of HIV transmission. Many lacked confidence in U = U and counselled on consistent condom use even after viral suppression while some expressed concerns that communicating this message to people living with HIV (PLHIV) would lead them to engage in multiple sexual relationships. Other providers reported that they did not counsel about the reduced risk of HIV transmission after viral suppression for fear of being blamed if HIV transmission occurred. HIV‐negative partners reported being informed about U = U by providers but they did not believe nor trust the message. Even after their partners achieved viral suppression, some HIV‐negative partners were unwilling to stop PrEP, while others indicated that they would use condoms if they stopped PrEP to be sure that they were protected from HIV. Conclusions Despite awareness that effective ART use eliminates HIV transmission risk, there is both a lack of in‐depth knowledge and conviction about the strategy among health providers and HIV‐negative partners in serodiscordant relationships. New strategies that go beyond communicating the science of U = U to consider the local social and clinical environments could maximize the effectiveness of U = U.

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Section: Methodsmentioning

confidence: 99%

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

et al. 2020

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“…The Partners Scale‐Up Project is an implementation study documenting the process of catalysing PrEP delivery in Kenya (Clinicaltrials.gov NCT03052010) . The work is being conducted in 24 public HIV care health facilities in central and western Kenya, specifically Kiambu, Kirinyaga, Muranga and Nyeri counties (HIV prevalence approximately 4%) and Homabay, Kisumu, Migori and Siaya counties (HIV prevalence approximately 15%) (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…Between January and July 2017, providers in these clinics were trained in PrEP delivery, using training manuals covering PrEP and ART delivery developed in part with the Kenya Ministry of Health . As of August 2018, over 3500 individuals had initiated PrEP in these facilities, most (87%) in HIV serodiscordant relationships .…”

Section: Methodsmentioning

confidence: 99%

“…Between monthly visits, TA teams also documented phone calls they received from clinic staff, which occurred occasionally, including reason for the calls and their resolution. Qualitative interviewers and TAs held weekly meetings to discuss concerns and gaps in knowledge or delivery and to ensure that the two data collection systems were aligning .…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported, in a demonstration project at four clinics in Kenya and Uganda, that integrated offering of PrEP and ART to HIV serodiscordant couples resulted in near‐elimination of HIV transmission risk in that population . A national scale‐up of PrEP delivery for HIV serodiscordant couples in Kenya (the Partners Scale‐up Project) is currently ongoing, with the goal of catalysing nationwide integration of PrEP in HIV care clinics using existing facility infrastructure and personnel capacity . Concurrent with Kenyan national scale‐up of PrEP, the Kenyan Ministry of Health recently issued guidance recommending PNS to increase the uptake of HIV testing in partners of PLHIV, creating an enabling environment for PNS to interface with other services .…”

Section: Introductionmentioning

confidence: 99%

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Integrating PrEPintoHIVcare clinics could improve partner testing services and reinforce mutual support among couples: provider views from a PrEPimplementation project in Kenya

et al. 2019

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Introduction Partner notification services (PNS) increase the HIV status knowledge and linkage to care and treatment. However, it is unclear if PNS can facilitate linkage of HIV‐negative partners to prevention services such as pre‐exposure prophylaxis (PrEP). Using qualitative methods, we explored provider perspective regarding the interaction of PrEP availability, PNS and antiretroviral treatment (ART) outcomes within a project integrating PrEP services into HIV care clinics in eight counties in western and central Kenya. Methods From May 2017 to August 2018, data on integrated PrEP service delivery including its interaction with PNS were collected through 71 key informant in‐depth interviews with healthcare providers and 24 standardized technical assistance reports summarizing implementation at the participating clinics. Thus, the perspective was from that of providers; analyses focused on emergent themes relating PNS to PrEP and ART services. Results Providers found that PrEP integration provided an additional concrete prevention option for HIV‐negative partners and created a motivation to offer PNS to persons living with HIV. PrEP availability also seemed to operate as an incentive for those living with HIV to participate in PNS, which in turn enhanced identification of potential PrEP clients and created an environment for discussing HIV transmission risk. Providers commented that initiating HIV‐negative partners on PrEP enhanced mutual monitoring of health outcomes, including improved adherence to ART by partners living with HIV. Clinics noted prioritizing people living with HIV with detectable viral loads for PNS in order to identify HIV‐negative partners who would benefit most from PrEP. Providers felt motivated by the apparent synergistic interaction of PNS, PrEP and ART. Conclusions Providers felt that the integration of PrEP into HIV care clinics stimulated the provision of PNS, and PNS was used to improve the identification of potential PrEP clients. The integrated combination of PNS, PrEP and ART is synergistic and should be promoted in HIV clinics.

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HIV risk and pre‐exposure prophylaxis interest among women seeking post‐abortion care in Kenya: a cross‐sectional study

et al. 2021

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Introduction: Post-abortion clinics located in regions with high HIV burden may ideal locations to integrate counselling and delivery of HIV pre-exposure prophylaxis (PrEP), aligning with normative goals for integrated delivery of HIV and reproductive health care. The objective of this study was to gauge the degree to which Kenyan women seeking care for a pregnancy loss, including induced abortion, are at risk for HIV and whether women would welcome an introduction to PrEP prior to discharge from post-abortion care. Methods: We conducted a mixed-methods study from August 2019 to February 2020 with women ages 15 to 30 recruited sequentially as they were accessing post-abortion care at public and private facilities in Thika and Kisumu, Kenya. Data collection was through a cross-sectional survey and laboratory testing for common sexually transmitted infections (N = 200), and indepth interviews (N = 30). Descriptive statistics summarize PrEP knowledge and referrals and a multivariable log-link binomial model estimated correlates of receiving a referral for PrEP. Qualitative data were analysed using inductive and deductive approaches. Results: Among 200 HIV-negative women (median age 21.0, interquartile range 19.0 to 22.0), the prevalence of Chlamydia trachomatis was 18.2% and Neisseria gonorrhoeae was 2.0%. Half of the women scored ≥5 on a validated tool that would correspond to an expected HIV incidence of 9.5% per year. Approximately half (55.8%) of women were familiar with PrEP prior to the study and 33.3% received a referral from study staff to a clinic offering PrEP. In qualitative interviews, women expressed interest in accessing PrEP from the gynaecology ward that provided post-abortion care but they preferred alternative locations for PrEP refills. Conclusions: Kenyan women accessing post-abortion care have substantial HIV risk and were favourable about the idea of receiving support to initiate PrEP as part of care offered during post-abortion care. These settings can be integrated into national PrEP programmes as locations providing PrEP referrals and initiation.

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Scale up of PrEP integrated in public health HIV care clinics: a protocol for a stepped-wedge cluster-randomized rollout in Kenya

Cited by 26 publications

References 33 publications

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

“I just believe there is a risk” understanding of undetectable equals untransmissible (U = U) among health providers and HIV‐negative partners in serodiscordant relationships in Kenya

Integrating PrEPintoHIVcare clinics could improve partner testing services and reinforce mutual support among couples: provider views from a PrEPimplementation project in Kenya

HIV risk and pre‐exposure prophylaxis interest among women seeking post‐abortion care in Kenya: a cross‐sectional study

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