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Two Thirds of Oral PrEP Users in Kenya Study Would Prefer Long-Acting Injectable
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IAS 2023, July 23-26, 2023, Brisbane
Mark Mascolini
Two thirds of Kenyans currently getting daily oral preexposure prophylaxis (PrEP) from private pharmacies said they would prefer long-acting injected PrEP over daily oral PrEP [1]. Among women respondents ranking three HIV-prevention strategies, , the vaginal ring came in third in order of preference.
Kenya has begun using private pharmacies as a PrEP source for interested people qualifying for this HIV-prevention measure. A collaborative stakeholder consultation created a model for pharmacy-delivered PrEP services [2]. When a pharmacy client expresses interest in PrEP, the provider invites the client into a private room and assesses PrEP eligibility with a standardized checklist. If needed, an off-site clinician is available for consultation, and clients needing a higher level of care get referred to a clinic. The provider dispenses PrEP to eligible clients and schedules a follow-up visit.
Researchers who worked on this PrEP pharmacy model tested it in a pilot study extension which ran from February through July 2022 at 12 pharmacies in two Kenyan counties. The Ministry of Health donated PrEP drugs, which are free to clients, and the pharmacy gets $100 per month. As part of this pilot, male and female current PrEP clients were asked which option they would choose if they could pick between getting an injection every 2 months and taking an oral pill every day. Women were asked to rank their preference among a daily PrEP pill, an every-2-month PrEP shot, and a monthly vaginal ring.
The analysis involved 496 PrEP clients attending their month-1 follow-up visit. Respondents had a median age of 25 years, 55% were female, and 74% were unmarried. From 62% to 86% of respondents reported multiple sex partners, sex partners of unknown HIV status, and/or inconsistent condom use.
Among all 496 respondents, 65% preferred an every-2-month injection and 35% opted for daily oral PrEP. Injection preference rates varied by gender and age: 54% of females under 25, 57% of males under 25, 64% of males 25 or older, and 79% of females 25 or older preferred injectable PrEP to oral PrEP.
Among women asked to rank the three PrEP options, 58% rated the injectable their top choice, 30% favored the pill, and only 2 respondents made the vaginal ring their first choice.
The investigators noted three potential limitations of their study: (1) They surveyed only clients who returned for follow-up, and responses may have differed in people who stopped daily PrEP and did not return for follow-up. (2) Preferences stated in a survey may not translate into actual uptake because of factors like cost and new information on efficacy and side effects. (3) Private pharmacies may attract clients who differ in important ways from other potential PrEP users.
The researchers underlined the importance of differences in PrEP preference in different subgroups, advising that PrEP-dispensing facilities should offer both long-acting injectables and daily pills to meet the needs of all clients.
References
1. Roche S, Omallo V, Mogere P, et al. Anticipated preferences for long-acting HIV PrEP among current oral PrEP users at pharmacies: Findings from a pilot study extension. IAS 2023, July 23-26, 2023. Brisbane.
2. Ortblad KF, Mogere P, Roche S, et al. Design of a care pathway for pharmacy-based PrEP delivery in Kenya: results from a collaborative stakeholder consultation. BMC Health Services Research. 2020; 20: Article number 1034.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05898-9
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