Barriers to and strategies for early implementation of pharmacy-delivered HIV PrEP services in Kenya: An analysis of routine data.
Barriers to and strategies for early implementation of pharmacy-delivered HIV PrEP services in Kenya: An analysis of routine data.
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DOI：
10.3389/frph.2023.1023568
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发表时间：
2023
影响因子：
--
通讯作者：
Ortblad, Katrina F.
中科院分区：
文献类型：
--
作者：
Nakambale, Hilma N.;Roche, Stephanie D.;Mogere, Peter;Omollo, Victor;Kuo, Alexandra P.;Stergachis, Andy;Baeten, Jared M.;Bukusi, Elizabeth;Ngure, Kenneth;Mugambi, Melissa Latigo;Ortblad, Katrina F.
对于在获得基于诊所的艾滋病毒暴露前预防 (PrEP) 方面面临挑战的个人，需要差异化的服务提供模式来扩大可及性和覆盖范围。在肯尼亚测试一种新型药房提供的口服 PrEP 模型的试点研究期间，我们使用常规程序数据来确定早期实施障碍以及提供者和研究人员为应对这些障碍而采取的行动。我们对基苏木县和基安布县的 5 家私人药房的药房提供者进行了培训，以启动并继续为有艾滋病毒感染风险的客户提供 PrEP，每次就诊费用为 300 肯尼亚先令（约 3 美元），使用处方清单并在远程临床医生的监督下进行。驻扎在药房的研究助理使用结构化模板完成药房提供的 PrEP 服务的每周观察报告。我们使用内容分析方法分析了实施前 6 个月的报告，并确定了多层次的早期实施障碍以及为解决这些障碍而采取的行动。然后，我们根据实施研究综合框架（CFIR）组织了已确定的障碍和行动。从2020年11月到2021年5月，研究助理完成了74份观察报告（∼18/药房）。在此期间，药房提供者筛选了 496 名潜在 PrEP 客户，确定 425 名有资格获得药房提供的 PrEP 服务，并为 230 名（54%）启动了 PrEP； 197 名有资格继续 PrEP 的客户中有 125 名 (63%) 补充了 PrEP。我们发现药房提供的 PrEP 服务存在以下早期实施障碍（按 CFIR 领域）：客户成本高（干预特征）、客户在与提供者讨论性行为和 HIV 检测时感到不适（外部环境）、提供者因 PrEP 交付耗时且破坏其工作流程而感到沮丧（内部环境）、以及由于担心鼓励性乱（个人特征），提供者对提供 PrEP 犹豫不决。为了帮助解决这些问题，药房提供者为潜在的 PrEP 客户实施了行为 HIV 风险评估的自我筛查选项，允许灵活的预约安排，并为新雇用的员工进行药房 PrEP 培训。我们的研究深入了解了在肯尼亚实施药房提供的 PrEP 服务的早期障碍以及缓解这些障碍的潜在行动。它还演示了如何使用常规编程数据来了解早期实施过程。
For individuals who face challenges accessing clinic-based HIV pre-exposure prophylaxis (PrEP), differentiated service delivery models are needed to expand access and reach. During a pilot study testing a novel pharmacy-delivered oral PrEP model in Kenya, we used routine programmatic data to identify early implementation barriers and actions that providers and study staff took in response to the barriers. We trained pharmacy providers at five private pharmacies in Kisumu and Kiambu Counties to initiate and continue clients at risk of HIV acquisition on PrEP for a fee of 300 KES per visit (∼$3 USD) using a prescribing checklist with remote clinician oversight. Research assistants stationed at the pharmacies completed weekly observation reports of pharmacy-delivered PrEP services using a structured template. We analyzed reports from the first 6 month of implementation using content analysis and identified multi-level early implementation barriers and actions taken to address these. We then organized the identified barriers and actions according to the Consolidated Framework for Implementation Research (CFIR). From November 2020 to May 2021, research assistants completed 74 observation reports (∼18/pharmacy). During this period, pharmacy providers screened 496 potential PrEP clients, identified 425 as eligible for pharmacy-delivered PrEP services, and initiated 230 (54%) on PrEP; 125 of 197 (63%) clients eligible for PrEP continuation refilled PrEP. We identified the following early implementation barriers to pharmacy-delivered PrEP services (by CFIR domain): high costs to clients (intervention characteristics), client discomfort discussing sexual behaviors and HIV testing with providers (outer setting), provider frustrations that PrEP delivery was time-consuming and disruptive to their workflow (inner setting), and provider hesitancy to deliver PrEP due to concerns about encouraging sexual promiscuity (characteristics of individuals). To help address these, pharmacy providers implemented a self-screening option for behavioral HIV risk assessment for prospective PrEP clients, allowed flexible appointment scheduling, and conducted pharmacy PrEP trainings for newly hired staff. Our study provides insight into early barriers to implementing pharmacy-delivered PrEP services in Kenya and potential actions to mitigate these barriers. It also demonstrates how routine programmatic data can be used to understand the early implementation process.
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影响因子：
2.9
作者：
Hernandez, Julie H.;Mbadu, Muanda Fidele;Glover, Annie
通讯作者：
Glover, Annie
DOI：
10.1186/s13012-015-0242-0
发表时间：
2015-04-21
期刊：
Implementation science : IS
影响因子：
--
作者：
Nilsen P
通讯作者：
Nilsen P
影响因子：
3.3
作者：
Ortblad KF;Mawandia S;Bakae O;Tau L;Grande M;Mogomotsi GP;Mmatli E;Ngombo M;Seckel L;Heffron R;Pintye J;Ledikwe J
通讯作者：
Ledikwe J
影响因子：
4.6
作者：
Gonsalves, Lianne;Wyss, Kaspar;Hilber, Adriane Martin
通讯作者：
Hilber, Adriane Martin
影响因子：
5.7
作者：
Stetler, CB;Legro, MW;Smith, JL
通讯作者：
Smith, JL