Abstract Body

Private-sector pharmacies are ubiquitous in many African countries yet underutilized for delivery of HIV prevention services, including pre- and post-exposure prophylaxis (PrEP and PEP). This is a missed opportunity, as pharmacies are staffed by medical professionals (e.g., pharmacists, pharmaceutical technologists); are frequently accessed for sexual and reproductive health products (e.g., contraception, treatment for sexually transmitted infections); and—unlike many healthcare facilities—are open evenings and weekends. Additionally, research evidence suggests that some individuals prefer accessing PrEP/PEP at private pharmacies over public clinics because of their convenience, privacy, and lack of HIV stigma. Key barriers to pharmacy-delivered PrEP/PEP services, however, include gaps in enabling policy and guidelines (e.g., limitations to pharmacy providers’ scope of practice) and private pharmacies’ exclusions from pooled PrEP/PEP procurement mechanisms that are critical to keeping the cost of PrEP/PEP affordable to clients. In collaboration with the Kenya Ministry of Health, our research team developed a care pathway for pharmacy-delivered PrEP/PEP that enables trained pharmacy providers (working under remote clinician oversight) to deliver drugs procured from government stock to eligible clients. Pilot studies have found this delivery approach reaches demographics underrepresented in clinic-based PrEP/PEP programs (e.g., men, unmarried individuals) and is highly acceptable and feasible to pharmacy clients and providers. Implementation challenges, however, include heavy burden on provider time (particularly for conducting the requisite HIV testing and counseling) and evidence gaps around how government might subsidize pharmacy PrEP/PEP delivery in ways that incentivize pharmacy providers and keep services affordable for clients. To fill these gaps, our research team is conducting hybrid cluster-randomized controlled trials to test different pharmacy PrEP/PEP delivery models that vary client cost and cadre of staff involved in delivery. In this presentation, we will present key implementation insights from these trials to date and potential paths forward.