在线艾滋病毒预防用药：肯尼亚 ePrEP 试点研究方案。
Online HIV prophylaxis delivery: Protocol for the ePrEP Kenya pilot study.
机构信息
Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, WA, United States.
出版信息
Front Public Health. 2023 Feb 24;11:1054559. doi: 10.3389/fpubh.2023.1054559. eCollection 2023.
BACKGROUND
Online pharmacies in Kenya provide sexual and reproductive health products (e.g., HIV self-testing, contraception) and could be leveraged to increase the reach of HIV pre-exposure and post-exposure prophylaxis (PrEP/PEP) to populations who do not frequently attend health facilities. To date, evidence is limited for operationalizing online PrEP/PEP delivery and the type of populations reached with this differential service delivery model.
METHODS
The ePrEP Kenya Pilot will deliver daily oral PrEP and PEP MYDAWA, a private online pharmacy retailer, to clients in Nairobi for 18 months. Potential clients will obtain information about PrEP/PEP on MYDAWA's sexual wellness page and self-screen for HIV risk. Individuals ≥18 years, identified as at HIV risk, and willing to pay for a blood-based HIV self-test and PrEP/PEP delivery will be eligible for enrollment. To continue with online PrEP/PEP initiation, eligible clients will purchase a blood-based HIV self-test for 250 KES (USD 2) [delivered to their setting of choice for 99 KES (USD 1)], upload an image of their self-test result, and attend a telemedicine visit with a MYDAWA provider. During the telemedicine visit, providers will screen clients for PrEP/PEP eligibility, including clinical concerns (e.g., kidney disease), discuss self-test results, and complete counseling on PrEP/PEP use and safety. Providers will refer clients who self-test HIV positive or report any existing medical conditions to the appropriate services at healthcare facilities that meet their preferences. Eligible clients will be prescribed PrEP (30-day PrEP supply at initiation; 90-day PrEP supply at follow-up visits) or PEP (28-day supply) for free and have it delivered for 99 KES (~USD 1). We will measure PrEP and PEP initiation among eligible clients, PEP-to-PrEP transition, PrEP continuation, and implementation outcomes (e.g., feasibility, acceptability, and costs).
DISCUSSION
Establishing pathways to increase PrEP and PEP access is crucial to help curb new HIV infections in settings with high HIV prevalence. The findings from this study will provide evidence on the implementation of online pharmacy PrEP and PEP service delivery that can help inform guidelines in Kenya and similar settings.
背景
肯尼亚的网上药店提供性健康和生殖健康产品（例如 HIV 自我检测、避孕药具），可以利用这些药店将 HIV 暴露前预防和暴露后预防（PrEP/PEP）服务提供给那些不常去医疗机构的人群。迄今为止，关于实施网上 PrEP/PEP 服务和利用这种差异化服务模式触达的人群类型，证据有限。
方法
ePrEP 肯尼亚试点项目将通过在线药店零售商 MYDAWA 向内罗毕的客户提供每日口服 PrEP 和 PEP。潜在客户将在 MYDAWA 的性健康页面上获取有关 PrEP/PEP 的信息，并进行 HIV 风险自我筛查。年龄在 18 岁及以上、被认定有 HIV 风险且愿意支付基于血液的 HIV 自我检测和 PrEP/PEP 费用的个人将有资格参加该项目。为了继续进行网上 PrEP/PEP 启动，符合条件的客户将购买基于血液的 HIV 自我检测，费用为 250 肯尼亚先令（KES）（2 美元）[可选择送到他们所在的地方，费用为 99 KES（1 美元）]，上传自我检测结果的图像，并与 MYDAWA 供应商进行远程医疗访问。在远程医疗访问期间，医生将筛查客户是否有资格接受 PrEP/PEP，包括临床问题（如肾病），讨论自我检测结果，并完成有关 PrEP/PEP 使用和安全性的咨询。如果客户自我检测 HIV 呈阳性或报告任何现有医疗状况，医生将把他们转介到符合其偏好的医疗保健机构的相应服务。符合条件的客户将免费获得 PrEP（启动时提供 30 天的 PrEP 供应；在后续访问时提供 90 天的 PrEP 供应）或 PEP（28 天供应），并收取 99 KES（~1 美元）的费用。我们将衡量合格客户中 PrEP 和 PEP 的启动情况、PEP 到 PrEP 的转换情况、PrEP 的持续情况以及实施结果（例如可行性、可接受性和成本）。
讨论
建立增加 PrEP 和 PEP 可及性的途径对于帮助遏制高 HIV 流行地区的新 HIV 感染至关重要。这项研究的结果将提供有关在线药店 PrEP 和 PEP 服务提供的实施情况的证据，这有助于为肯尼亚和类似环境制定指南。
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