August 21, 2020

Delivery of Integrated PrEP and ART for HIV prevention for couples in Kenya

Dr. Jared Baeten

Funding has been awarded to principal investigator Dr. Jared Baeten by the National Institute of Mental Health for "Delivery of Integrated PrEP and ART for HIV prevention for couples in Kenya."



Maximizing access is key challenges for optimizing the public health impact of pre-exposure prophylaxis (PrEP) for HIV prevention. The coronavirus disease 2019 (COVID-19) epidemic has overwhelmed health systems globally. In Africa, PrEP has been added to an already-burdened health infrastructure, and the overlay of COVID-19 threatens derail the tremendous progress made with HIV treatment and prevention, including provision of PrEP.

Since 2017, in collaboration with the Kenyan Ministry of Health, we have been conducting a large step-wedge randomized roll-out of PrEP delivery in 24 high-volume, PEPFAR-supported, public HIV care facilities, using detailed data abstraction from clinic records and implementation science methods (including the RE-AIM framework), plus training and technical assistance in another ~70 clinics outside of the randomized trial (together, the work is called the Partners Scale-Up Project). We have found high enthusiasm among providers and clients, with good uptake, continuation, and adherence for PrEP and clinic-initiated adaptions that may PrEP delivery more efficient.

During the current COVID-19 emergency, we have continued remote provision of technical assistance to monitor implementation progress and cross-pollinate best practices across clinics. We are hearing that health providers feel ill-prepared to manage or screen for COVID-19 but nevertheless remain committed to serving clients. Clinics have rapidly accelerated adaptations to continue services provision, including dispensing longer PrEP refills, quickly initiating one-stop provision of PrEP services (to minimize staff-client contact), and shifting PrEP services to HIV testing centers and potentially to community-based delivery. Incredibly, PrEP initiations/refills are continuing at a rate similar to 2019. Thus, we hypothesize that despite the alarming implications for individuals and health systems of the COVID-19 emergency, there is both resilience of public health clinic staff and opportunity for health systems to adapt and innovate efficient strategies for provision of critical services.

In this administrative supplement, we propose to add a novel aim (Aim 5) to explore the impact of COVID-19 on PrEP services, specifically clinic adaptation and staff resilience. We propose to document and accelerate rapid adaptations in PrEP services across the ~100 clinics across Kenya in our network, using our technical assistance model to cross-pollinate best practices that mitigate COVID-19 impacts. Qualitative interviews will explore provider distress and identify key components of resilience and PrEP service adaptation. The work is fully within the scope of our ongoing project, which has explicit goals of understanding barriers and facilitating innovations for PrEP delivery for providers and health systems. Given our robust technical assistance network and data collection systems (including phone/video interviews), this work can begin immediately and will be translatable to PrEP delivery across Africa during this public health emergency.

Sponsor Award Number: 3R01MH095507-10S1