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Implementation Science at UW

Keywords: Task-shifting

✪ Design of a care pathway for pharmacy-based PrEP delivery in Kenya: Results from a collaborative stakeholder consultation

Authors:

Katrina F. Ortblad, Peter Mogere, Stephanie Roche, Kevin Kamolloh, Josephine Odoyo, Elizabeth Irungu, Nelly R. Mugo, Jillian Pintye, Jared M. Baeten, Elizabeth Bukusi, Kenneth Ngure & on Behalf of Stakeholders for Pharmacy-based PrEP Delivery in Kenya Consultation

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2020

Read the full text in the open access journal BMC Health Services Research

Abstract:

Introduction

In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at HIV clinics. Developing novel PrEP delivery models is important for increasing the reach of PrEP. Delivery of PrEP through pharmacies is one approach utilized in the US to improve accessibility. Retail pharmacies are commonly used as a first-line access point for medical care in Kenya, but have not been utilized for PrEP delivery. We conducted a collaborative consultative meeting of stakeholders to develop a care pathway for pharmacy-based PrEP delivery in Kenya.

Methods

In January 2020, we held a one-day meeting in Nairobi with 36 stakeholders from PrEP regulatory, professional, healthcare service delivery, civil society, and research organizations. Attendees reviewed a theory of change model, results from formative qualitative research with pharmacy providers and clients, and anticipated core components of pharmacy-based PrEP delivery: counseling, HIV testing, prescribing, and dispensing. Stakeholders participated in small and large group discussions to identify potential challenges and solutions. We synthesized the key findings from these discussions.

Results

Stakeholders were enthusiastic about a model for pharmacy-based PrEP delivery. Potential challenges identified included insufficient pharmacy provider knowledge and skills, regulatory hurdles to providing affordable HIV testing at pharmacies, and undefined pathways for PrEP procurement. Potential solutions identified included having pharmacy providers complete the Kenya Ministry of Health-approved PrEP training, use of a PrEP prescribing checklist with remote clinician oversight and provider-assisted HIV self-testing, and having the government provide PrEP and HIV self-testing kits to pharmacies during a pilot test. A care pathway was developed over the course of the meeting.

Conclusions

PrEP delivery stakeholders in Kenya were strongly supportive of developing and testing a model for pharmacy-based PrEP delivery to increase PrEP access. We collaboratively developed a care pathway for pilot testing that has the potential to expand PrEP delivery options in Kenya and other similar settings.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ A phased approach to implementing the Breast Imaging Reporting and Data System (BI‐RADS) in low‐income and middle‐income countries

Authors:

Diana L. Lam, Pegah Entezari, Catherine Duggan, Zeridah Muyinda, Andres Vasquez, Jorge Huayanay, Benjamin O. Anderson, & John R. Scheel

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: April 2020

Read the full text in the open access journal Cancer

Abstract:

Background

Successful breast cancer detection programs rely on standardized reporting and interpreting systems, such as the Breast Imaging Reporting and Data System (BI‐RADS), to improve system performance. In low‐income and middle‐income countries, evolving diagnostic programs have insufficient resources to either fully implement BI‐RADS or to periodically evaluate the program's performance, which is a necessary component of BI‐RADS. This leads to inconsistent breast ultrasound interpretation and a failure to improve performance.

Methods

The authors applied the Breast Health Global Initiative's phased implementation strategy to implement diagnostic ultrasound and BI‐RADS within the context of a limited‐resource setting.

Results

The authors recommended starting with triage ultrasound to distinguish suspicious masses from normal breast tissue and benign masses such as cysts because the majority of health workers performing ultrasounds at this level have minimal breast imaging experience. Transitioning to full diagnostic ultrasound with condensed or full BI‐RADS should occur after performance and quality metrics have been met.

Conclusions

Transitioning through these phases across facilities likely will occur at different times, particularly in rural versus urban settings.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

Effectiveness of Task-Shifted Trauma-Focused Cognitive Behavioral Therapy for Children Who Experienced Parental Death and Posttraumatic Stress in Kenya and Tanzania

Authors:

Shannon Dorsey, Leah Lucid, Prerna Martin, Kevin M. King, Karen O’Donnell, Laura K. Murray, Augustine I. Wasonga, Dafrosa K. Itemba, Judith A. Cohen, Rachel Manongi, Kathryn Whetten

University of Washington affiliated authors are displayed in bold.

Published: January 2020

Read the full text in the subscription access journal JAMA Psychiatry

A Pharmacist-Led, Same-Day, HIV Pre-Exposure Prophylaxis Initiation Program to Increase PrEP Uptake and Decrease Time to PrEP Initiation

Authors:

Christine M. Khosropour, Kandis V. Backus, Arianna R. Means, Laura Beauchamps, Kendra Johnson, Matthew R. Golden, and Leandro Mena

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: January 2020

Read the full text in the subscription access journal AIDS Patient Care and STDs