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