Sila Joseph, Wagner Anjuli Dawn, Abuna Felix, Dettinger Julia C, Odhiambo Ben, Ngumbau Nancy, Oketch George, Sifuna Enock, Gómez Laurén, Hicks Sarah, Weiner Bryan J, John-Stewart Grace, Kinuthia John
Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, WA, USA.
Implement Sci Commun. 2025 May 12;6(1):58. doi: 10.1186/s43058-025-00746-5.
Pre-exposure prophylaxis (PrEP) is recommended for HIV prevention in pregnant and postpartum women at substantial ongoing risk for HIV. In resource-limited settings, there exist gaps in the integration of PrEP into antenatal care.
We conducted a difference-in-differences analytic approach (3 months pre- and 3 months post) between January 2022 and July 2022 in 8 facilities (4 intervention and 4 comparison) in western Kenya. During the 6-month period, we tested a combination of 2 stakeholder selected implementation strategies - retraining health providers and fast tracking PrEP clients- to improve PrEP delivery. All study facilities dispensed PrEP in the Maternal and Child health clinics (MCH). We evaluated absolute changes in: PrEP penetration, PrEP fidelity, client PrEP knowledge, client satisfaction, and client waiting and service times as outcomes specified a priori while PrEP offer and HIV testing were outcomes specified post hoc. We measured acceptability and appropriateness by providers of the implementation strategies using AIM and IAM respectively.
We observed statistically significant improvements in PrEP penetration and PrEP offer (p < 0.05) and non-significant improvements in fidelity. PrEP penetration increased 6 percent points (p = 0.002), PrEP offer increased nearly 6 percentage points (p = 0.002), and PrEP fidelity increased 4 percentage points (p = 0.202) in intervention vs comparison facilities. Client PrEP knowledge increased 0.45 out of 7 total points (p < 0.001) and PrEP screening increased 13 percentage points (p = 0.001). We observed no significant changes in service time (0.13-min increase; p = 0.249), waiting time (0.03-min decrease; p = 0.796), or client satisfaction (0.04/24 total point decrease; p = 0.849) in intervention vs comparison facilities. HIV testing did not significantly change (7 percentage point decrease, p = 0.305). The implementation strategy bundle was deemed appropriate and acceptable by the providers (appropriateness: 18.5/20; acceptability: 18.5/20). Overall, the implementation strategy bundle was associated with larger increases in implementation outcomes among women receiving a visit other than their first ANC visit, as well as among sites without stockouts of HIV test kits.
A stakeholder-selected implementation strategy bundle that included retraining healthcare workers, fast tracking PrEP clients to reduce waiting time, and PrEP dispensing in MCH improved several implementation outcomes without significantly affecting waiting time or reducing service time.
对于持续面临高感染风险的孕妇和产后女性，推荐采用暴露前预防（PrEP）措施预防艾滋病毒感染。在资源有限的环境中，将PrEP纳入产前护理存在差距。
2022年1月至2022年7月，我们在肯尼亚西部的8个机构（4个干预组和4个对照组）采用了差异分析方法（前3个月和后3个月）。在这6个月期间，我们测试了两种利益相关者选定的实施策略的组合——对医护人员进行再培训以及加快PrEP服务对象的流程——以改善PrEP服务的提供。所有研究机构均在妇幼保健诊所（MCH）发放PrEP。我们评估了以下方面的绝对变化：PrEP普及率、PrEP依从性、服务对象的PrEP知识、服务对象满意度以及服务对象的等待时间和服务时间，这些是预先确定的结果，而PrEP提供和艾滋病毒检测是事后确定的结果。我们分别使用AIM和IAM来衡量实施策略的提供者对其可接受性和适宜性的评价。
我们观察到PrEP普及率和PrEP提供率有统计学意义的改善（p < 0.05），而依从性有不显著的改善。与对照组机构相比，干预组机构的PrEP普及率提高了6个百分点（p = 0.002），PrEP提供率提高了近6个百分点（p = 0.002），PrEP依从性提高了4个百分点（p = 0.202）。服务对象的PrEP知识在总分7分中提高了0.45分（p < 0.001），PrEP筛查率提高了13个百分点（p = 0.001）。我们观察到，与对照组机构相比，干预组机构的服务时间（增加0.13分钟；p = 0.249）、等待时间（减少0.03分钟；p = 0.796）或服务对象满意度（总分24分中减少0.04分；p = 0.849）均无显著变化。艾滋病毒检测没有显著变化（下降7个百分点，p = 0.305）。提供者认为实施策略组合是适宜且可接受的（适宜性：18.5/20；可接受性：18.5/20）。总体而言，实施策略组合与首次产前检查以外接受检查的女性以及没有艾滋病毒检测试剂盒缺货的机构中实施成果的更大提升相关。
利益相关者选定的实施策略组合，包括对医护人员进行再培训、加快PrEP服务对象流程以减少等待时间以及在妇幼保健诊所发放PrEP，改善了多项实施成果，而没有显著影响等待时间或缩短服务时间。
