TESTING A LAY COUNSELOR-LED PrEP DELIVERY MODEL IN PUBLIC HEALTH FACILITIES IN KENYA

Kenya Medical Research Institute (Kemri), Nairobi

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT The overall goal of the proposed K43 award Emerging Global Leader Award is to support Dr. Elizabeth Irungu?s research training to develop as an independent global health HIV researcher. Conducting the study proposed in this application will facilitate her training goals to: 1) gain expertise in the design and conduct quasi-experimental studies in real world settings, 2) gain a solid foundation in organizational behavior theory and research, and 3) acquire expertise in conducting stakeholder analysis. This proposal builds on unique skills she already has in clinical trials, epidemiology and implementation science. The research goal of this proposal is to test a novel PrEP delivery approach that may improve the flow and uptake of PrEP in public HIV clinics in Kenya. In Africa, PrEP is being added to an already-burdened health infrastructure and the ability of the health systems to build sustainable PrEP programs will necessitate making service delivery both time-efficient and patient-centered. While there is high enthusiasm and uptake for PrEP delivered in public HIV clinics, the delivery of PrEP in these clinics, however, can be burdensome with multiple stops (for HIV testing, triage, clinical review, and dispensing) and long waiting times between stops and stigma associated with being in a HIV clinic. To address these PrEP implementation gaps, Dr Irungu will conduct a quasi-experimental study to test if a lay counselor-led PrEP delivery model will result in reduced waiting time in clinics, improved PrEP uptake and continuation and be delivered with fidelity (Aim 1). Up to 300 PrEP users ? both newly initiating and continuing PrEP ? will be enrolled during two serial, twelve-month observation periods (N=150/period): 1) a standard-of-care PrEP delivery period (to serve as a near- contemporaneous control) and 2) a lay-counselor led PrEP delivery period. In-depth interviews with health providers in participating pilot clinics will be conducted to elucidate organizational determinants of implementation of this novel PrEP delivery model (Aim 2). In addition, key PrEP delivery stakeholders in Kenya, identified through stakeholder analysis, will be interviewed to categorize their interest in lay counselor PrEP delivery and power to influence PrEP delivery policies, and to understand their perspectives about task shifting of PrEP services to lay counselors. Dr Irungu?s research goals align with her training goals and at the completion of this award, she will be in an excellent position to submit an R01 application to further advance HIV prevention implementation research.