Streamlining the Efficiency of PrEP Implementation

HIV Prevention Clinical Trial

— Efficiency  

Official title:

An Implementation Project to Improve the Efficiency of PrEP Delivery in Public Health HIV Care Clinics in Kenya

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04424524
• Other study ID #: STUDY00007949
• Secondary ID: R00MH118134
• Status: Completed
• Start date: May 1, 2020
• Est. completion date: April 30, 2024

Study information

• Verified date: May 2024
• Source: University of Washington
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

This is a pilot facility-based direct-to-pharmacy PrEP refill delivery to streamline care pathway in Kenyan public health HIV facilities implementing PrEP. Data on up to 500 PrEP users will be evaluated to understand delivery efficiency and in-depth interview with users and delivery key informants will be conducted to identify barriers and facilitators of implementation.

Description:

A prospective, pilot implementation evaluation of patient-centered differentiated care service. The core components of the multifaceted implementation strategy include: 1) 3-monthly refills, 2) direct-to-pharmacy refill visits, 3) HIV self-testing (HIVST) while waiting for refills, 4) Rapid risk assessment for ongoing risk, adherence, side effect, and acute HIV symptoms. Clinics will implement either: 1) current PrEP patient flow without any change or 2) a pilot differentiated pharmacy-based follow up PrEP care pathway. Clinics will implement only one delivery model thus eliminating risk for confusion in the clinic about delivery models and permitting a full-scale test of the system, since the efficiency in PrEP delivery is in part at the system level, above and beyond the individual client encounter. For this pilot project designed to primarily test delivery efficiency, feasibility and acceptability of direct-to-pharmacy care pathway at systems level using existing public health infrastructure, pilot and control clinics will be of comparable size selected to reflect the implementation nature of the design.

The specific aims are:

Aim 1: To evaluate whether a differentiated care model improves the efficiency of PrEP delivery while resulting in equivalent or better: 1) patient waiting time, 2) early PrEP continuation, and 3) adherence.

Aim 2: Conduct mixed-methods study to understand patient and provider perception, experiences , feasibility and acceptability of a differentiated PrEP delivery model.

Aim 3: Assess the efficiency, cost and cost-effectiveness of a facility-based differentiated PrEP care.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 746
• Est. completion date: April 30, 2024
• Est. primary completion date: June 30, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

For HIV-negative participants:

• Of legal age (=18 years)

• Able and willing to provide written informed consent for research component of the project (blood draw for adherence, brief surveys and in-depth qualitative interviews)

• HIV uninfected based on negative HIV tests, per Kenya national guidelines

• Currently or previously accessed PrEP at participating HIV clinic

For Key delivery informants:

• Able willing and able to provide consent in order to participate in the survey and qualitative interviews.

• Works at any of the clinics implementing PrEP delivery. Key informants may include HIV testing service nurses, counselors, clinicians, social workers, or clinic managers.

Exclusion Criteria:

• Not meeting any of the inclusion criteria listed above.

Related Conditions & MeSH terms

• HIV Preexposure Prophylaxis
• HIV Prevention
• Implementation

Locations

Country	Name	City	State
Kenya	Partners in Health Research and Development	Thika

Sponsors (2)

Lead Sponsor	Collaborator
University of Washington	National Institute of Mental Health (NIMH)

Country where clinical trial is conducted

Kenya, 

References & Publications (1)

Zewdie KB, Ngure K, Mwangi M, Mwangi D, Maina S, Etyang L, Maina G, Ogello V, Owidi E, Mugo NR, Baeten JM, Mugwanya KK. Effect of differentiated direct-to-pharmacy PrEP refill visits supported with client HIV self-testing on clinic visit time and early Pr — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Patient wait time	Total waiting time at the clinic and contact time with providers measured by time and motion studies	up to 6 months
Primary	PrEP continuation	Measured by return to clinic for PrEP refill	up to 6 months
Primary	PrEP adherence	Measured objectively through tenofovir levels in dried blood spots at random subset of PrEP visits	up to 6 months
Primary	Acceptability of direct-to-pharmacy PrEP care pathway	Assessed by the Acceptability of Intervention Psychometric Measure (AIM)	up to 6 months
Primary	Acceptability of user HIV self-testing for PrEP care pathway	Assessed by the Acceptability of Intervention Psychometric Measure (AIM)	up to 6 months
Primary	Feasibility of direct-to-pharmacy PrEP care pathway	Assessed by the Feasibility of Intervention Psychometric Measure (FIM)	up to 6 months
Secondary	Barriers to implementation of direct-to-pharmacy PrEP care pathway in Kenyan public health HIV clinics	Evaluated through in-depth and key informants qualitative interviews	up to 6 months
Secondary	Facilitators to implementation of direct-to-pharmacy PrEP care pathway in Kenyan public health HIV clinics	Evaluated through in-depth and key informants qualitative interviews	up to 6 months
Secondary	Fidelity of implementing of direct-to-pharmacy PrEP care pathway in Kenyan public health HIV clinics	Extent to which core components of the direct-to-pharmacy PrEP care pathway are implemented as intended will be evaluated through checklists and surveys with clinic managers	up to 6 months
Secondary	Safety of HIV self-testing	Accuracy of HIV self-testing measured by frequency false negative and positive tests.	up to 6 moths
Secondary	Reasons for PrEP discontinuation	Measured through in-depth qualitative interviews and surveys with persons who discontinue PrEP use	up to 6 months
Secondary	Cost of implementing direct-to-pharmacy PrEP care pathway in Kenyan public health HIV clinics	Measured through micro-activity costing and time and motion studies	up to 6 months