Healthcare provider perspectives on the benefits and barriers of integrating PrEP into FP services in Kenya

Abstract

Objective: Young women of childbearing age experience disproportionately higher rates of HIV acquisition. Family planning clinics are highly accessed by this population and serve as a potential location to provide HIV prevention services, most notably, PrEP. Study Design: Nested within the Family Planning Plus (FP+) study, the aim of this thesis is to assess key influences on the feasibility and acceptability of integration of PrEP into FP clinics. The FP+ study is a stepped wedge cluster randomized clinical trial (RCT) designed to evaluate how service integration affects PrEP uptake among women accessing public FP clinics in Kenya and potential barriers and facilitators of integration. Methods: We conducted interviews with HCWs to qualitatively assess healthcare worker experiences providing integrated PrEP in 4 FP clinics from step 1 of the RCT. Interviews were led by two trained social scientists, and were audio-recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and interpretation. Thematic analysis was used to identify determinants (barriers and facilitators) of integrating PrEP into FP clinics. Results: A total of 16 IDIs were conducted with HCWs. We identified three main themes from the HCWs’ interviews that summarized key influences on implementation. First, training ensures HCWs have the knowledge and information to counsel women and prioritize PrEP delivery. Secondly, HCWs discussed the importance of having available resources, including staff and time to properly execute integration of PrEP in FP clinics. Finally, we found that engagement with community partners reduced stigma related to taking PrEP, positively influencing uptake among women. Conclusions: Integration of PrEP in FP clinics will require community sensitization to reduce stigma, training HCWs on PrEP provision, and identifying strategies that can relieve increased workload for FP HCWs.