Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultatio
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(2020) 20:1034
RESEARCH ARTICLE
Open Access
Design of a care pathway for pharmacybased PrEP delivery in Kenya: results from a collaborative stakeholder consultation Katrina F. Ortblad1* , Peter Mogere2, Stephanie Roche1, Kevin Kamolloh3, Josephine Odoyo3, Elizabeth Irungu1,2, Nelly R. Mugo2,4, Jillian Pintye1,5, Jared M. Baeten1,6,7, Elizabeth Bukusi1,3,8, Kenneth Ngure2,9 on Behalf of Stakeholders for Pharmacy-based PrEP Delivery in Kenya Consultation
Abstract Introduction: In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya. Methods: In January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions. Results: Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting. Conclusions: PrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings. Keywords: PrEP, HIV prevention, Pharmacy care, Kenya, Stakeholders, Implementation science
* Correspondence: [email protected] 1 Department of Global Health, International Clinical Research Center, University of Washington, 908 Jefferson St, 12th floor, Seattle, WA 98104, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed
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