PrEP: A Tool Against HIV in Africa

To address PrEP implementation in Kenya, a team of researchers evaluated practices and contextual modifications across public HIV clinics.

In our fight against HIV/AIDS, pre-exposure prophylaxis (PrEP) is one of the most effective strategies we have. Millions of people around the world are impacted by HIV/AIDS and despite decades of research and work, we are still struggling to get ahead of this infectious disease.

In Kenya, it’s estimated that 1.4 million adults and children are living with HIV and the prevalence rate is 4.2 for those aged 15-49 year. The prevalence rate is highest in women aged 15 to 49 years with HIV and in 2020, there were 33,000 newly infected children and adults. As PrEP has been highly recommended from the World Health Organization (WHO) as an effective strategy to prevent HIV and help break the chain of infection. The hard part though, is that despite this effective strategy and the disproportionate impact of HIV/AIDS on Africa, scaling up has met several roadblocks.

To address PrEP implementation in Kenya, a team of researchers evaluated practices and contextual modifications across public HIV clinics. Researchers drew from the Partners Scale-Up Project, which provided PrEP across 25 public HIV clinics, where they performed qualitative interviews and observed the clinics through technical assistance reports.

Each clinic provided several services to the community—HIV testing, HIV risk assessments, PrEP education and adherence counseling, and other services outlined by the Kenyan Ministry of Health PrEP protocols. Moreover, the team reviewed any modifications these clinics made to improve delivery services and help incorporate better PrEP services.

The authors found that, “most clinics initiated clients on PrEP without creatinine testing if otherwise healthy. While monthly refill appointments are recommended, a majority of clinics issued PrEP users two to three months of pills at a time. Clinics also implemented practices that had not been specified in the guidelines including incorporating PrEP-related topics into routine health talks, calling clients with missed PrEP appointments, discussing PrEP service delivery in regular staff meetings, ‘fast-tracking’ PrEP clients and dispensing PrEP in clinic rooms rather than at clinic-based pharmacies. PrEP initiation numbers were highest among clinics that did not require creatinine testing, conducted peer on-the-job PrEP training and those that dis- cussed PrEP delivery in their routine meetings. Above-average continuation was observed among clinics that discussed PrEP in their routine meetings, dispensed PrEP in clinic rooms and offered PrEP at nonregular hours.”

The clinics consistently asked clients to return monthly but often struggled with creatinine testing and completing clinic encounter forms fully. Nearly all clinics did a monthly HIV test, which is helpful, especially as they consistently did phone calls as outreach to their PrEP clients who failed to show for an appointment. Fast-tracking PrEP clients and on-the-job training helped improve public HIV clinic practices to ensure better delivery to clients.

As the authors emphasized, while there may be national guidance for public HIV clinics, it’s important that they modify practices to meet the needs of the community, meaning we should encourage clinic-level efforts.