Ekwunife Obinna I, Omenoba Theodora C, Eyong Ugochi, Okelu Valentine, Alagbile Michael, Ume Ifeanyi, Eze Ambrose, Fisayo Aderinola, Aidoo-Frimpong Gloria, Shroff Farah, Anyakora Chimezie
Division of Population Health, Department of Medicine, University at Buffalo, New York, 14203, USA.
Department of Clinical Pharmacy and Pharmacy Management, Veritas University, Abuja, Nigeria.
BMC Health Serv Res. 2024 Dec 18;24(1):1621. doi: 10.1186/s12913-024-12107-4.
HIV remains a significant public health problem, particularly in Africa, where two-thirds of global cases occur. Nigeria is among the three countries with the highest burden. Despite free access to pre- and post-exposure prophylaxis (PrEP and PEP) in Nigerian hospitals, stigma, distance, and restrictive clinic hours hinder uptake, especially among vulnerable populations. Building on the successful pilot implementation of pharmacy-based PrEP delivery in Kenya, we engaged Nigerian stakeholders in adapting the model, addressing user and provider concerns to ensure effective implementation in Nigeria.
The stakeholder meeting took place in Abuja, Nigeria, which is selected for its central location and accessibility to various stakeholders, particularly those involved in HIV prevention efforts. The participants were purposefully selected to ensure diverse representations, including youth who are potential PrEP users, pharmacy providers, regulators, and representatives from civil society organizations. The meeting utilized the Nominal Group Technique (NGT)-a structured method for facilitating group decision-making and prioritizing ideas-to adapt the Kenyan pharmacy-delivered PrEP model for implementation in the Nigerian context. Mock role play was conducted to help participants understand the care pathway. The discussions culminated in identifying challenges and viable strategies for implementing the model in Nigeria.
The one-day stakeholder meeting on 9 October 2024 was attended by 20 participants from various sectors involved in HIV prevention services. Stakeholders expressed enthusiasm for pharmacy-based PrEP delivery while acknowledging challenges associated with clinic-based services, such as stigma, limited hours, and long wait times. The key recommendations included training pharmacy providers, increasing awareness, ensuring confidentiality, establishing referral linkages, and integrating program data into the Health Management Information System (HMIS) as well as ensuring commodity availability and access. To enhance the success of the pilot study, stakeholders proposed engaging a research assistant, forming a monitoring team, and submitting the results to the Pharmacy Council of Nigeria (PCN) for review.
The identified challenges and strategies for implementing the model in Nigeria will inform the development of a refined pharmacy-delivered PrEP framework that is ready for pilot testing and potential scaling across the country.
艾滋病毒仍然是一个重大的公共卫生问题，尤其是在非洲，全球三分之二的病例发生在该地区。尼日利亚是负担最沉重的三个国家之一。尽管尼日利亚的医院可免费提供暴露前和暴露后预防（PrEP和PEP）服务，但耻辱感、距离以及有限的门诊时间阻碍了人们的接受，尤其是在弱势群体中。基于肯尼亚成功试点实施的基于药房的PrEP服务，我们让尼日利亚的利益相关者参与调整该模式，解决用户和提供者的担忧，以确保在尼日利亚有效实施。
利益相关者会议在尼日利亚的阿布贾举行，选择此地是因其地理位置居中，便于各利益相关者参与，特别是那些参与艾滋病毒预防工作的人员。有目的地挑选参与者以确保有不同的代表，包括可能使用PrEP的青年、药房提供者、监管者以及民间社会组织的代表。会议采用名义小组技术（NGT）——一种促进群体决策和确定想法优先级的结构化方法——来调整肯尼亚基于药房提供PrEP的模式，以便在尼日利亚实施。进行了模拟角色扮演，以帮助参与者了解护理流程。讨论最终确定了在尼日利亚实施该模式的挑战和可行策略。
2024年10月9日举行为期一天的利益相关者会议，来自参与艾滋病毒预防服务的各个部门的20名参与者出席了会议。利益相关者对基于药房的PrEP服务表示出热情，同时也承认基于诊所的服务存在一些挑战，如耻辱感、门诊时间有限和等待时间长。主要建议包括培训药房提供者、提高认识、确保保密性、建立转诊联系、将项目数据整合到健康管理信息系统（HMIS）以及确保药品供应和可及性。为提高试点研究的成功率，利益相关者提议聘请一名研究助理、组建一个监测团队，并将结果提交给尼日利亚药房理事会（PCN）进行审查。
确定的在尼日利亚实施该模式的挑战和策略将为制定一个完善的基于药房的PrEP框架提供参考，该框架可用于试点测试并有可能在全国推广。
