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Research
Preparing for the delivery of PrEP: Lessons from the implementation of integrated reproductive health and HIV services in Kenya
Emily McDonald Evens
FHI 360
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7369-458X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: In 2015, the WHO issued guidelines recommending oral pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV. Given their role in health service delivery, ministries of health are assuming major responsibility for PrEP services in sub-Saharan Africa. However, these are often strained and under-resourced. We measured the delivery of selected integrated services and identified the factors that impede effective delivery of integrated services to prepare for the integration of PrEP into health services for women.
Methods: Three services were examined: 1) HIV testing within family planning, 2) HIV testing within general outpatient services, and 3) care and prevention services for HIV-positive clients not eligible for antiretrovirals (“Pre-ART”). Descriptive, mixed-methods research was conducted in three Kenyan counties using: service delivery observations (n = 3246) and client exit interviews (n = 3257) in public facilities, and semi-structured interviews with providers, managers and officials (n = 112).
Results: Integrated services were not consistently implemented. HIV testing was not systematically offered or received; most clients were not aware testing was available, and tests were largely unavailable. Pre-ART services did not systematically deliver mandated services. Rates of cervical cancer and tuberculosis screening were especially low; a concerning gap given the elevated risk for HIV-positive women. Supply-side challenges of staffing, infrastructure and commodity shortages were common.
Conclusions: In an era of significant demands on treatment resources and decreasing funding for prevention, the identification of the technical, material, and human resources required for successful and sustainable delivery of integrated services must be addressed to support successful PrEP implementation.
Key words: Pre-exposure prophylaxis, Kenya, Integrated health, HIV
Keywords
Pre-exposure prophylaxis, Kenya, Integrated health, HIV
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This is a preprint. It has not completed peer review.
Research
Preparing for the delivery of PrEP: Lessons from the implementation of integrated reproductive health and HIV services in Kenya
Emily McDonald Evens
FHI 360
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7369-458X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 20 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: In 2015, the WHO issued guidelines recommending oral pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV. Given their role in health service delivery, ministries of health are assuming major responsibility for PrEP services in sub-Saharan Africa. However, these are often strained and under-resourced. We measured the delivery of selected integrated services and identified the factors that impede effective delivery of integrated services to prepare for the integration of PrEP into health services for women.
Methods: Three services were examined: 1) HIV testing within family planning, 2) HIV testing within general outpatient services, and 3) care and prevention services for HIV-positive clients not eligible for antiretrovirals (“Pre-ART”). Descriptive, mixed-methods research was conducted in three Kenyan counties using: service delivery observations (n = 3246) and client exit interviews (n = 3257) in public facilities, and semi-structured interviews with providers, managers and officials (n = 112).
Results: Integrated services were not consistently implemented. HIV testing was not systematically offered or received; most clients were not aware testing was available, and tests were largely unavailable. Pre-ART services did not systematically deliver mandated services. Rates of cervical cancer and tuberculosis screening were especially low; a concerning gap given the elevated risk for HIV-positive women. Supply-side challenges of staffing, infrastructure and commodity shortages were common.
Conclusions: In an era of significant demands on treatment resources and decreasing funding for prevention, the identification of the technical, material, and human resources required for successful and sustainable delivery of integrated services must be addressed to support successful PrEP implementation.
Key words: Pre-exposure prophylaxis, Kenya, Integrated health, HIV
Figure 1