Delivery of integrated PrEP and ART for HIV prevention for couples in Kenya

Abstract: Maximizing access is one of the key challenges for optimizing the public health impact of pre-exposureprophylaxis (PrEP) for HIV prevention. The coronavirus disease 2019 (COVID-19) epidemic has overwhelmedhealth systems globally. In Africa, PrEP has been added to an already-burdened health infrastructure, and theoverlay of COVID-19 threatens derail the tremendous progress made with HIV treatment and prevention,including provision of PrEP. Since 2017, in collaboration with the Kenyan Ministry of Health, we have beenconducting a large step-wedge randomized roll-out of PrEP delivery in 24 high-volume, PEPFAR-supported,public HIV care facilities, using detailed data Abstract: Ion from clinic records and implementation science methods(including the RE-AIM framework), plus training and technical assistance in another ~70 clinics outside of therandomized trial (together, the work is called the Partners Scale-Up Project). We have found high enthusiasmamong providers and clients, with good uptake, continuation, and adherence for PrEP and clinic-initiatedadaptions that may PrEP delivery more efficient. During the current COVID-19 emergency, we have continuedremote provision of technical assistance to monitor implementation progress and cross-pollinate best practicesacross clinics. We are hearing that health providers feel ill-prepared to manage or screen for COVID-19 butnevertheless remain committed to serving clients. Clinics have rapidly accelerated adaptations to continueservices provision, including dispensing longer PrEP refills, quickly initiating one-stop provision of PrEP services(to minimize staff-client contact), and shifting PrEP services to HIV testing centers and potentially to community-based delivery. Incredibly, PrEP initiations/refills are continuing at a rate similar to 2019. Thus, we hypothesizethat despite the alarming implications for individuals and health systems of the COVID-19 emergency, there isboth resilience of public health clinic staff and opportunity for health systems to adapt and innovate efficientstrategies for provision of critical services. In this administrative supplement, we propose to add a novel aim (Aim5) to explore the impact of COVID-19 on PrEP services, specifically clinic adaptation and staff resilience. Wepropose to document and accelerate rapid adaptations in PrEP services across the ~100 clinics across Kenyain our network, using our technical assistance model to cross-pollinate best practices that mitigate COVID-19impacts. Qualitative interviews will explore provider distress and identify key components of resilience and PrEPservice adaptation. The work is fully within the scope of our ongoing project, which has explicit goals ofunderstanding barriers and facilitating innovations for PrEP delivery for providers and health systems. Given ourrobust technical assistance network and data collection systems (including phone/video interviews), this workcan begin immediately and will be translatable to PrEP delivery across Africa during this public health emergency.