Acceptability of direct to pharmacy pathway to improve efficiency of PrEP delivery in Kenya

Abstract

Background: PrEP is a highly effective and safe medication that reduces the risk of HIV acquisition. Differential service delivery methods, such as direct to pharmacy (DTP) refills and HIV self-testing (HIVST), are promising adaptations to PrEP delivery that could reduce barriers to both patients and providers particularly in resource constrained settings.Methods: We conducted a cross sectional quantitative survey with PrEP providers at two public health facilities implementing DTP refills and HIVST. We used the implementation outcomes framework developed by Proctor et al. to guide our implementation evaluation. We assessed outcomes of acceptability, appropriateness, and feasibility of the two interventions with a validated questionnaire on a 5-point Likert scale. Means for each outcome were compared across demographic and professional characteristics using one-way analysis of variance (ANOVA). Results: A total of 145 providers completed the survey, of which 31% were HIV testing counselors, 17.9% were peer educators or other counselors, 11.7% were clinicians, 6.9% were nurses, 1.4% were in-charge administrators, and 31% reported “other” for healthcare worker cadre. Both DTP and HIVST were found to be widely acceptable with ≥ 86% of all respondents reporting that they agree or completely agree across all three implementation outcomes. The average response for direct to pharmacy refill outcomes were acceptability = 4.21, appropriateness = 4.20, and feasibility = 4.19. The average response value for HIV self-testing outcomes were acceptability = 4.18, appropriateness = 4.20, and feasibility = 4.22. One way ANOVA for each implementation outcome and each key provider characteristic (e.g., sex, provider cadre, clinic location, duration of service years, and history of PrEP delivery) did not show statistically significant differences detected in mean responses to the constructs by individual characteristic. Conclusion: In this study we found direct to pharmacy refills and HIV self-testing were acceptable forms of differentiated PrEP delivery among healthcare workers in central Kenya. These strategies should be considered when scaling up pharmacy-based PrEP services in resource constrained settings.