Hicks Sarah, Abuna Felix, Odhiambo Ben, Dettinger Julia C, Sila Joseph, Oketch George, Sifuna Enock, Ngumbau Nancy, Gómez Laurén, John-Stewart Grace C, Kinuthia John, Wagner Anjuli D
Department of Epidemiology, University of Washington, Seattle, WA, United States.
Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Front Reprod Health. 2023 Jul 6;5:1206150. doi: 10.3389/frph.2023.1206150. eCollection 2023.
Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up.
The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts.
Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; < 0.001).
PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.
孕期和产后感染艾滋病毒的风险很高，建议对围产期人群进行暴露前预防（PrEP）。将PrEP纳入母婴健康（MCH）诊所是可行且可接受的。了解诊所的服务可用性和准备情况对于有效扩大规模至关重要。
“孕期PrEP，加速覆盖与效率”研究（PrEPARE；NCT04712994）让肯尼亚西部先前参与过项目或研究的具备PrEP经验的机构，通过一项经过修改的服务可用性和准备情况评估（SARA）调查来记录可用服务和物资，该调查有20个PrEP追踪项目，涵盖人员配备/指南、服务/设备以及药品/物资。机构先前的研究参与时间为2017年至2019年；SARA调查数据于2020年4月至2021年6月收集。描述性统计按先前的研究参与情况进行分层。方差分析测试评估机构特征与差距之间的关联。费舍尔检验评估物资可用性和缺货情况的差异。
在接受调查的55家机构中，60%在过去两年接受过PrEP培训，95%提供纳入MCH的PrEP，分别有64%和78%在PrEP和艾滋病毒检测服务（HTS）提供空间具备听觉和视觉隐私。监督频率各不相同，但82%在3个月内接受过一次监督访问。物资可用性各不相同，最常缺货的物资是MCH中的PrEP（71%可用）、风险评估筛查工具（RAST）和PrEP卡（分别为60%和75%可用）。每家机构的服务和物资差距数量从0到8不等（中位数：3；四分位距：2，5）。最常见的差距是：PrEP培训和风险评估卡（各占40%）、PrEP空间缺乏隐私（36%）以及艾滋病毒检测服务空间缺乏隐私（31%）、MCH中的PrEP药丸（29%）和PrEP卡（25%）。按县、先前的研究参与情况或公立与私立状态划分，平均差距数量没有差异。4级机构的差距（平均2.2）比2级、3级和5级机构少（分别为平均5.7、4.5和5.3；<0.001）。
MCH机构中PrEP服务的可用性和准备情况总体较高。然而，需要增加针对保真度的提供者培训和支持性监督的频率。为解决关键物资缺货问题，如PrEP药丸，可能需要实施电子物流管理信息系统。针对这些差距对于有效扩大PrEP综合服务的规模至关重要，尤其是在基础设施有限的机构中。
