Roche Stephanie D, Omollo Victor, Mogere Peter, Asewe Magdaline, Gakuo Stephen, Banerjee Preetika, Harkey Kendall, Sharma Monisha, Pintye Jillian, Mugambi Melissa Latigo, Shah Parth, Odoyo Josephine, Ong'wen Patricia, Were Daniel, Bukusi Elizabeth A, Ngure Kenneth, Ortblad Katrina F
Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
J Int AIDS Soc. 2025 Jun;28 Suppl 1(Suppl 1):e26467. doi: 10.1002/jia2.26467.
INTRODUCTION: Private pharmacies in Africa reach individuals with ongoing and periodic HIV risk, yet few countries currently leverage pharmacies as an HIV service delivery platform. We conducted a 6-month pilot to evaluate a model for pharmacy provider-led delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) in Kenya. METHODS: At 12 private pharmacies in Kisumu and Kiambu Counties, licensed pharmacy providers initiated and managed eligible clients ≥18 years on PrEP and PEP under remote clinician supervision (NCT04558554); four of these pharmacies additionally offered sextually transmitted infection (STI) testing. PrEP/PEP clients were scheduled for follow-up 1 month later and then quarterly (PrEP clients only). Primary outcomes included PrEP and PEP initiation and continuation during the pilot period. Client and providers rated the model across multiple constructs of acceptability and feasibility from established frameworks. RESULTS: From January to July 2022, 1028 clients interested in PrEP, PEP and/or STI testing were screened and 829 initiated one or more service: 661 PrEP, 162 PEP and 52 STI testing. About half of clients (48%, 398/829) were male, most were unmarried (78%, 644/829) and PrEP-naïve (89%, 737/829), and the median age was 25 years (IQR 22-31). Most PrEP clients reported inconsistent condom use (88%, 581/661) or sex with partners of unknown HIV status (70%, 460/661) in the past 6 months. Most PEP clients reported condomless sex (48%, 78/162) or a condom break (46%, 75/162) in the past 72 hours; 4% (6/162) reported sexual assault. Among PrEP clients eligible for a refill, 73% (479/658) refilled at least once and 60% (197/328) twice. Among PEP clients eligible for follow-up, 44% (65/148) completed follow-up HIV testing and 20% (30/148) transitioned to PrEP. Among STI clients, 19% (10/52) tested positive for gonorrhoea (n = 7) and/or chlamydia (n = 5). Most clients and providers (≥92%) found the delivery model and its implementation strategies acceptable. All providers (n = 12) thought it was possible to deliver PrEP and PEP at pharmacies in Kenya. CONCLUSIONS: Pharmacy PrEP/PEP delivery achieved high uptake, continuation and acceptability among eligible clients that could benefit, highlighting the potential of pharmacies to expand HIV prevention service coverage in Kenya, particularly to individuals not accessing these services at clinics.
引言：非洲的私人药店能接触到有持续和周期性艾滋病毒感染风险的人群，但目前很少有国家将药店作为艾滋病毒服务提供平台。我们进行了一项为期6个月的试点，以评估肯尼亚由药剂师主导提供艾滋病毒暴露前预防（PrEP）和暴露后预防（PEP）的模式。 方法：在基苏木县和基安布县的12家私人药店，有执照的药剂师在远程临床医生监督下，为符合条件的18岁及以上客户启动并管理PrEP和PEP（NCT04558554）；其中4家药店还提供性传播感染（STI）检测。PrEP/PEP客户在1个月后安排随访，然后每季度随访一次（仅PrEP客户）。主要结局包括试点期间PrEP和PEP的启动和持续情况。客户和提供者根据既定框架对该模式在多个可接受性和可行性结构方面进行评分。 结果：2022年1月至7月，对1028名对PrEP、PEP和/或STI检测感兴趣的客户进行了筛查，829人启动了一项或多项服务：661人接受PrEP，162人接受PEP，52人接受STI检测。约一半客户（48%，398/829）为男性，大多数未婚（78%，644/829）且未接受过PrEP（89%，737/829），中位年龄为25岁（四分位间距22 - 31岁）。大多数PrEP客户报告在过去6个月中避孕套使用不规律（88%，581/661）或与艾滋病毒感染状况不明的伴侣发生性行为（70%，460/661）。大多数PEP客户报告在过去72小时内有无保护性行为（48%，78/162）或避孕套破裂（46%，75/162）；4%（6/162）报告遭受性侵犯。在符合再次配药条件的PrEP客户中，73%（479/658）至少再次配药一次，60%（197/328）再次配药两次。在符合随访条件的PEP客户中，44%（65/148）完成了随访艾滋病毒检测，20%（30/148）转为接受PrEP。在STI客户中，19%（10/52）淋病检测呈阳性（n = 7）和/或衣原体检测呈阳性（n = 5）。大多数客户和提供者（≥92%）认为该服务提供模式及其实施策略是可接受的。所有提供者（n = 12）认为在肯尼亚的药店提供PrEP和PEP是可行的。 结论：药店提供PrEP/PEP在可能受益的符合条件客户中实现了高接受率、持续率和可接受性，突出了药店在肯尼亚扩大艾滋病毒预防服务覆盖范围的潜力，特别是对于那些未在诊所获得这些服务的个人。
Lancet HIV. 2023-12
J Racial Ethn Health Disparities. 2024-6
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