The delivery of oral HIV pre-exposure prophylaxis (PrEP) at retail pharmacies has the potential to overcome existing barriers to clinic-delivered PrEP services, including HIV-associated stigma, long wait times, and understaffing. We pilot tested a model of pharmacy-based PrEP initiation and refills in Kenya – the first of its kind in sub-Saharan Africa.
At five retail pharmacies (two in Kisumu and three in Thika) we piloted a model of pharmacy-based PrEP delivery developed in collaboration with Kenyan stakeholders (CT.gov: NCT04558554). In this model, pharmacy providers (pharmacists and pharmaceutical technologists) asked clients purchasing services potentially indicating HIV risk (e.g., emergency contraception, STI treatment) if they might be interested in PrEP for HIV prevention. These providers screened interested clients for HIV risk (using Kenya’s Rapid Assessment Screening Tool), counseled them on PrEP safety, tested them for HIV using oral-fluid self-tests, and prescribed and dispensed PrEP with support from a remote clinician for clinically-challenging cases. Pharmacy providers were permitted PrEP prescribing authority for the pilot, and no additional staff provided PrEP care. PrEP supply was dispensed for one month at initiation and three months thereafter.
From November 2020 to October 2021, we screened 575 clients accessing services associated with HIV risk at retail pharmacies and initiated 287 (49%) on PrEP. Two-thirds (387/575) of clients screened reported a sexual partner of unknown HIV status, and 63% (362/575) reported inconsistent condom use. Among clients initiating PrEP, the median age was 26 years (IQR 22-33), 43% (124/287) were female, and 38% (108/287) were married. Most clients learned of pharmacy PrEP from the pharmacy provider (42%, 121/287) or via informal word-of-mouth referral (43%, 123/287). PrEP continuation was 54% (155/287) at one month, 35% (92/267) at four months, and 32% (29/92) at seven months.
Pharmacy-based PrEP delivery, conducted entirely by private-sector retail pharmacy staff, is a feasible new delivery model that has the potential to expand PrEP reach and access in Kenya and similar settings. Findings from this pilot suggest that populations at HIV risk frequently visit retail pharmacies and that PrEP initiation and continuation at pharmacies is similar to or exceeds that at clinics. More research is needed on the effectiveness of and costs associated with this novel model of PrEP delivery to inform scale up.