Title

HIV PrEP continuation among clients formerly engaged in PrEP services at private pharmacies participating in a pilot study in Kenya

Presenter

Victor Omollo

Authors

V. Omollo¹, S. D. Roche², P. Mogere³, P. Ongwen⁴, M. Asewe¹, P. Banjeree^2,2, G. Rota¹, P. Otieno¹, G. Maina⁵, R. Malen², K. Oware¹, J. Odoyo¹, D. Were⁴, E. A. Bukusi^1,6,7, K. Ngure⁸, K. F. Ortblad²

Institutions

¹Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya, ²Fred Hutchinson Cancer Center, Public Health Sciences Division, Seattle, United States, ³Novartis Pharmaceuticals, Basel, Switzerland, ⁴Jhpiego, Nairobi, Kenya, ⁵Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya, ⁶University of Washington, Global Health, Seattle, Kenya, ⁷University of Washington, Obstetrics and Gynecology, Seattle, Kenya, ⁸Jomo Kenyatta University of Agriculture and Technology, School of Public Health, Nairobi, Kenya

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) delivery at private pharmacies is a novel and promising differentiated service delivery model that could address access barriers to public clinic-based PrEP delivery. We measured post-study PrEP continuation (i.e., linkage to clinic-based PrEP services) among individuals who initiated PrEP at one of 12 private pharmacies participating in a six-month pilot study in Kisumu and Kiambu Counties, Kenya.
METHODS: During the pilot study (January-July 2022), clients that met the PrEP eligibility criteria were dispensed a 1-month PrEP supply at initiation and a 3-month supply at refill visits by trained pharmacy providers. Three months following pilot completion (October 2022), we followed up with participants who had initiated pharmacy PrEP services. In our follow-up phone surveys, former study participants reported on their current PrEP use, and, if applicable, location of PrEP access and/or reasons for discontinuation. We reported descriptive statistics.
RESULTS: We called 667 clients who initiated PrEP at pharmacies and reached 74% (492/667) of the participants called. The median age was 25 years (IQR 22-31), 43% (211/492) were male, and 76% (372/492) were unmarried. During the pilot study, most surveyed participants refilled PrEP at least once (79%, 388/492). Three months post-study completion, the majority of participants had stopped PrEP use (59%, 291/492). Reasons for stopping PrEP included: not wanting to get PrEP from a clinic (60%, 175/291), no longer feeling at HIV risk (22%, 64/291), and testing HIV positive (4%, 13/291). Among the 201 clients still using PrEP, most obtained PrEP from a public clinic (59%, 118/201) and some from a private clinic (13%, 27/201). PrEP use three months post-study completion was greater among those who refilled PrEP at least once at the pharmacy (46%, 180/388) compared to those who never refilled PrEP at the pharmacy (20%, 21/104).
CONCLUSIONS: Stopping the delivery of PrEP services at private pharmacies following completion of a pilot study resulted in more than half of eligible users discontinuing use because they were not interested in clinic-delivered PrEP services. More research is needed to understand whether and how private pharmacies can be leveraged and sustained as PrEP service delivery points in Kenya and similar settings.

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