Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
Partners in Health and Research Development, Thika, Kenya.
J Acquir Immune Defic Syndr. 2023 Aug 15;93(5):379-386. doi: 10.1097/QAI.0000000000003208.
HIV pre-exposure prophylaxis (PrEP) delivery at private pharmacies is a promising new differentiated service delivery model that may address barriers to PrEP delivery at public health care facilities. We measured the fidelity of this model (ie, delivery as intended) in a pilot study in Kenya.
Five private, retail pharmacies in Kisumu and Thika Counties.
Trained pharmacy providers delivered PrEP services, including identifying eligible clients, counseling on HIV risk, assessing PrEP safety, testing for HIV, and dispensing PrEP. Pharmacy clients completed surveys that assessed the fidelity of the services received after each visit. Standardized client actors (ie, mystery shoppers) were trained on 4 different case scripts, then made unannounced pharmacy visits, and then completed a 40-item checklist that assessed the fidelity and quality of service delivery components.
From November 2020 to December 2021, 287 clients initiated and 159 (55%) refilled PrEP. At initiation, most clients were counseled on PrEP adherence (99%, 284 of 287) and potential side effects (97%, 279 of 287) and all received provider-assisted HIV self-testing before PrEP dispensing (findings consistent across refill visits). Nine standardized client actors completed 15 pharmacy visits. At each visit, most actors were asked about their behaviors associated with HIV risk (80%, 12/15) and all were counseled on PrEP safety and side effects. All actors reported that pharmacy providers treated them with respect.
In this first pilot study of pharmacy-delivered PrEP services in Africa, the fidelity of service delivery was high, suggesting that trained providers at private pharmacies can deliver quality PrEP services.
艾滋病毒暴露前预防（PrEP）在私人药店提供，是一种有前途的新的差异化服务提供模式，可能解决在公共卫生保健机构提供 PrEP 的障碍。我们在肯尼亚的一项试点研究中衡量了这种模式的保真度（即按预期提供）。
基苏木县和锡卡县的五家私人零售药店。
经过培训的药店供应商提供 PrEP 服务，包括确定符合条件的客户、对艾滋病毒风险进行咨询、评估 PrEP 的安全性、进行艾滋病毒检测和提供 PrEP。药店客户在每次就诊后完成评估所接受服务的保真度的调查。经过培训的标准化客户演员（即神秘顾客）接受了 4 种不同案例脚本的培训，然后进行了未经宣布的药店访问，然后完成了 40 项检查表，评估了服务提供组件的保真度和质量。
从 2020 年 11 月至 2021 年 12 月，287 名客户开始服用 PrEP，159 名（55%）客户进行了续药。在开始时，大多数客户接受了关于 PrEP 坚持服用（99%，284 名/287 名）和潜在副作用（97%，279 名/287 名）的咨询，并且在 PrEP 分发前，所有客户都接受了提供者辅助的艾滋病毒自我检测（在续药访问中发现了一致的结果）。9 名标准化客户演员完成了 15 次药店访问。在每次访问中，大多数演员都被问到与艾滋病毒风险相关的行为（80%，12/15），并且都接受了关于 PrEP 安全性和副作用的咨询。所有演员都报告说，药店供应商对他们表示尊重。
在非洲首次对药店提供的 PrEP 服务进行的试点研究中，服务提供的保真度很高，这表明经过培训的私人药店提供商可以提供高质量的 PrEP 服务。
