Evaluating sexually transmitted infections among adolescent girls and young women within a pharmacy-based PrEP delivery model in Kenya.

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ABSTRACT Sexually transmitted infections (STIs) disproportionately affect cisgender adolescent girls and young women (AGYW) who often experience STI complications, including infertility, chronic pelvic pain, and increased risk for HIV acquisition and peripartum morbidity. Approximately one in four AGYW in East Africa have Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), or syphilis. In Kenya, HIV and STIs among AGYW comprise a syndemic with 40% of new HIV infections occurring in AGYW, yet research to address STIs lags behind HIV in this population. The Kenya Ministry of Health is developing pharmacy-based delivery models for HIV pre-exposure prophylaxis (PrEP) to expand access. AGYW seeking contraception at pharmacies more frequently accept PrEP when offered and have behaviors associated with HIV risk compared with AGYW at facilities. Few data exist on the burden of STIs among AGYW accessing FP and/or PrEP outside of facilities— filling this evidence gap could inform high-yield strategies to address HIV and STIs. Our team currently leads a cluster RCT among AGYW in Kisumu, Kenya to test models of PrEP delivery at pharmacies for AGYW seeking contraception (R01HD108041)—as of June 2023, PrEP uptake is very high. Secondary outcomes include CT/NG prevalence in a subset of AGYW at 4 pharmacies. To date, all AGYW offered CT/NG testing accepted, and 26% had CT infections. Data from women at clinics in South Africa suggest that STI testing motivates PrEP use, yet it is unknown if STI testing influences PrEP use in pharmacy settings. In this supplement application, we propose a comprehensive evaluation of STIs among AGYW within a pharmacy-based PrEP delivery model (Aim 1), a longitudinal analysis to understand how STI testing and diagnoses influence PrEP use outcomes among AGYW (Aim 2), and a qualitative implementation evaluation to understand user experiences of STI testing in this unique context (Aim 3), which will combine to provide evidence for integrated PrEP/STI testing delivery for AGYW within pharmacies in Kenya. All aims are within the scientific scope of the parent study, expand ongoing study procedures and data collection, and leverage existing research infrastructure. By supplementing our ongoing cluster RCT comparing PrEP delivery models in retail pharmacies and collecting new STI data, including on molecular NG antimicrobial resistance detection, we are uniquely positioned to evaluate STIs among AGYW. Our team’s expertise in implementing HIV/STI studies among AGYW in pharmacies will enable us to execute the proposed work in one year. Our proposed study will provide evidence on the burden of STIs among AGYW accessing contraception and/or PrEP at pharmacies. We will ascertain data to guide STI testing in pharmacy PrEP models for AGYW, a priority group for HIV/STI prevention, and provide evidence applicable to broader populations.