Exploring synergies in pharmacy-based delivery of PrEP and contraception for adolescent girls and young women in Kenya - PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW; age 15-24) in East and southern Africa are disproportionately affected by poor sexual and reproductive health (SRH) outcomes related to HIV acquisition and unintended pregnancy. Despite increasing recognition of AGYW’s interrelated needs for HIV pre-exposure prophylaxis (PrEP) and family planning (FP) services, facility-based SRH programs struggle to reach at-risk AGYW and up to 50% of AGYW seek contraception outside of health facilities, including at retail pharmacies. Pharmacy-based care models can also increase options for expanding PrEP reach, and efforts are underway to implement pathways for pharmacy-delivered PrEP in Kenya, an African leader in PrEP implementation at scale where AGYW have been identified as a priority group. In collaboration with the Kenya Ministry of Health, our group is conducting a cluster randomized clinical trial (RCT) at 20 pharmacies in Kisumu, Kenya–a region with an HIV prevalence of up to 28% among women–to test the effectiveness of utilizing nurse-navigators at retail pharmacies to enhance AGYW PrEP use. This trial (R01HD108041, NCT05467306) will enroll 1900 AGYW seeking contraception at randomized pharmacies and participants will be offered daily oral PrEP and the dapivirine vaginal ring (DPV-VR) per national guidelines. The WHO and UNAIDS jointly recommend integrated FP and HIV prevention services, yet little is known about the interplay between PrEP and FP use among AGYW seeking care in pharmacies, limiting strategic co-delivery of AGYW-centered SRH services in this context. Given overlapping risk for unintended pregnancy and HIV among AGYW, integrated service delivery in pharmacies could provide positive synergy for acceptability and quality of FP and PrEP services. In this proposal, we apply an explanatory sequential mixed methods design to elucidate the synergies between pharmacy-based FP and PrEP use and service delivery among Kenyan AGYW, and to translate our findings into AGYW-centered implementation strategies for delivering quality integrated FP and PrEP in pharmacies. Aim 1 will use group-based trajectory modeling to identify FP use patterns associated with PrEP use outcomes among a cohort of 1900 AGYW, and to characterize the patterns’ sociodemographic, behavioral, and psychosocial correlates. In Aim 2, we will combine qualitative and human-centered design methods to contextualize synergies in pharmacy-based FP/PrEP use and inform testable implementation strategies for integrated service delivery. Guided by the Theoretical Domains Framework, we will determine the barriers and facilitators to integrated FP and PrEP provision for AGYW in pharmacies. We will triangulate this work with participatory workshop methods, engaging AGYW to identify key design elements for integrated pharmacy-based FP/PrEP implementation strategies. This will be the first study aiming to improve implementation of integrated FP and PrEP access for AGYW using a pharmacy-based model and will prime pharmacies to deliver multi-purpose technologies currently in the pipeline.
