Background
Kenya is experiencing rapid growth of e-pharmacy and telemedicine, which could be leveraged for delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) to groups not reached through traditional models. We conducted a pilot study in partnership with MYDAWA, a Kenyan online pharmacy, to evaluate a modified online PrEP & PEP delivery model in which HIV tests are not subsidized and includes a service fee, in Nairobi and Mombasa Counties.
Methods
Interested clients completed a teleconsultation to assess for eligibility based on Kenya national guidelines for PrEP/PEP; those eligible ordered an HIV self-test (HIVST) at $9.2/ $11 or a provider-administered rapid diagnostic test (RDT) for $6. Those testing HIV-negative received a 30-day supply of free-of-charge government donated PrEP/PEP. HIVST and PrEP/PEP were delivered to the client’s preferred location for $1.1. Clients who refilled PrEP at Month-1 received a 90-day supply. We conducted a descriptive analysis of PrEP/PEP service delivery data and fitted Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between user characteristics and PrEP outcomes.
Results
From January-September 2024, we screened 1,621 clients of whom 75 and 1140 were eligible for PrEP and PEP, respectively. Among these, 55 (73%) initiated PrEP and 835 (73%) initiated PEP. Most PrEP and PEP clients (n=890) were male (65.7%), ≥25 years (77.7%), unmarried (88.2%), PrEP (98.9%) and PEP (97%) naïve. Most clients (79%) opted for provider-administered RDT, while 21% purchased an HIVST. PrEP continuation was 31/48 (64.6%) at one month, 5/38 (13.2%) at 3 months, and 7/17 (41.2%) at 6 months. A total of 14.6% of clients who initiated PrEP discontinued and restarted, while 2.28% transitioned from PEP to PrEP. Male users were less likely to continue PrEP (HR 0.01, 95% CI 0.0002-0.70) while those with >1 partner were more likely to continue (HR 19.04, 95% CI 1.51-239.76). Having multiple partners was also associated with PEP to PrEP transition (p=0.0250).
Conclusions
Our findings suggest that online delivery can expand access to PrEP/PEP for clients not previously engaged with biomedical prevention, and that these clients are willing to pay for HIV testing and delivery. Persistent PrEP use among men remains a challenge, but high demand for online PEP and low transitions from PEP to PrEP suggest opportunities to expand access to PEP, which has been underutilized in HIV prevention efforts.