Findings from a pilot study of pharmacy-delivered oral HIV pre-exposure prophylaxis (PrEP) in Kenya suggest that pharmacies could be an acceptable PrEP delivery platform. Uptake and continuation rates were high and comparable to the usage patterns among clients of public HIV clinics.
Kenya is among several countries exploring ways to leverage the private sector for HIV service delivery.
In what the investigators called the first-of-its-kind evaluation, they conducted in-depth semi-structured interviews based on the Theoretical Framework of Acceptability with six providers at five pharmacies in Kenya’s Kisumu and Kiambu counties between November 2020 and December 2021.
Near the end of the study, the researchers sampled and interviewed 39 PrEP clients aged 18 years and above, all of whom paid 300 Kenyan shillings—approximately $3 US—for PrEP. They also interviewed licensed pharmaceutical technologists who delivered PrEP. The median age of all study participants was 30 years, and 25 (53%) were female.
A thematic analysis of the interview transcripts showed that pharmacy clients and providers accepted this delivery model on multiple dimensions, with all interviewees reporting that they generally approved of pharmacy-based PrEP delivery. Clients appreciated the privacy, convenience, speed, and quality of services, while providers valued the increase in clients and profits.
Most providers said their PrEP delivery workload was manageable, but several indicated that they would charge more in the future. Multiple clients reported that the 300 KES fee for PrEP was unaffordable and recommended decreasing it to 100-200 KES—around $1-2 US. One provider reported ethical issues and stopped delivering PrEP after 3 months because she thought it brought HIV stigma to her pharmacy.
Most providers reported that making PrEP available at pharmacies was a good way to reduce HIV incidence because many of their clients are sexually active, and pharmacy providers have the expertise required for PrEP delivery. All providers reported confidence in their ability to deliver PrEP.
The authors recommended that future research explore model adoption and sustainability, as well as ways to increase acceptability by lowering client fees and adopting alternative cost-sharing options.
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