Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Centre for Clinical Research, Kenya Medical Research Insititute, Nairobi, Kenya.
J Int AIDS Soc. 2023 Jun;26(6):e26131. doi: 10.1002/jia2.26131.
The delivery of daily, oral HIV pre-exposure prophylaxis (PrEP) at private pharmacies may overcome barriers to PrEP delivery at public healthcare facilities, including HIV-associated stigma, long wait times and overcrowding.
At five private, community-based pharmacies in Kenya, a care pathway for PrEP delivery (ClinicalTrials.gov: NCT04558554) was piloted-the first of its kind in Africa. Pharmacy providers screened clients interested in PrEP for HIV risk, then used a prescribing checklist to identify clients without medical conditions that might contraindicate PrEP safety, counsel them on PrEP use and safety, conduct provider-assisted HIV self-testing and dispense PrEP. For complex clinical cases, a remote clinician was available for consultation. Clients who did not meet the checklist criteria were referred to public facilities for free services delivered by clinicians. Pharmacy providers dispensed a 1-month PrEP supply at initiation and a 3-month supply thereafter at a client fee of 300 KES (∼$3 USD) per visit.
From November 2020 to October 2021, pharmacy providers screened 575 clients, identified 476 who met the prescribing checklist criteria and initiated 287 (60%) on PrEP. Among pharmacy PrEP clients, the median age was 26 years (IQR 22-33) and 57% (163/287) were male. The prevalence of behaviours associated with HIV risk among clients was high; 84% (240/287) reported sexual partners with unknown HIV status and 53% (151/287) reported multiple sexual partners (past 6 months). PrEP continuation among clients was 53% (153/287) at 1 month, 36% (103/287) at 4 months and 21% (51/242) at 7 months. During the pilot observation period, 21% (61/287) of clients stopped and restarted PrEP and overall pill coverage was 40% (IQR 10%-70%). Nearly, all pharmacy PrEP clients (≥96%) agreed or strongly agreed with statements regarding the acceptability and appropriateness of pharmacy-delivered PrEP services.
Findings from this pilot suggest that populations at HIV risk frequently visit private pharmacies and PrEP initiation and continuation at pharmacies is similar to or exceeds that at public healthcare facilities. Private pharmacy-based PrEP delivery, conducted entirely by private-sector pharmacy staff, is a promising new delivery model that has the potential to expand PrEP reach in Kenya and similar settings.
在私人药店提供每日口服 HIV 暴露前预防（PrEP）可能克服在公共医疗保健机构提供 PrEP 时面临的障碍，包括与 HIV 相关的污名、长时间等待和过度拥挤。
在肯尼亚的五家私人社区药店中，试点了 PrEP 提供的护理途径（ClinicalTrials.gov：NCT04558554）-这在非洲尚属首例。药店提供者对有兴趣接受 PrEP 的客户进行 HIV 风险筛查，然后使用处方检查表来确定没有可能影响 PrEP 安全性的医疗条件的客户，对他们进行 PrEP 使用和安全性方面的咨询，进行提供者辅助的 HIV 自我检测，并提供 PrEP。对于复杂的临床病例，远程临床医生可提供咨询。不符合检查表标准的客户被转介到公共设施，由临床医生提供免费服务。药店在初始阶段提供一个月的 PrEP 供应，此后每三个月提供一次，每次客户需支付 300 肯尼亚先令（约 3 美元）。
从 2020 年 11 月至 2021 年 10 月，药店提供者对 575 名客户进行了筛查，确定了 476 名符合处方检查表标准的客户，并为其中 287 名（60%）启动了 PrEP。在药店 PrEP 客户中，中位年龄为 26 岁（IQR 22-33），57%（163/287）为男性。与 HIV 风险相关的行为在客户中普遍存在；84%（240/287）报告性伴侣 HIV 状况未知，53%（151/287）报告有多个性伴侣（过去 6 个月）。客户在 1 个月时的 PrEP 持续使用率为 53%（153/287），4 个月时为 36%（103/287），7 个月时为 21%（51/242）。在试点观察期间，21%（61/287）的客户停止并重新开始使用 PrEP，总体药丸覆盖率为 40%（IQR 10%-70%）。几乎所有（≥96%）药店 PrEP 客户都同意或强烈同意有关药店提供的 PrEP 服务的可接受性和适当性的陈述。
这项试点研究的结果表明，处于 HIV 风险中的人群经常光顾私人药店，而在药店开始和继续接受 PrEP 的情况与在公共医疗保健机构相似或更高。完全由私营部门药店工作人员进行的基于私人药店的 PrEP 提供是一种有前途的新的提供模式，有可能扩大肯尼亚和类似环境中的 PrEP 覆盖面。
