SUMMARY
Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face a disproportionate burden
of HIV infection. Though highly effective HIV prevention like pre-exposure prophylaxis (PrEP) is central to the
global strategy for HIV epidemic control, awareness of PrEP among AGYW is low, with uptake and
continuation even lower—health systems are often ill equipped to overcome the numerous access barriers
faced by AGYW, including stigma, harmful norms, and the inconveniences of clinic-based health services.
There is growing recognition that community-based pharmacies have the potential to bridge gaps in HIV
prevention and mitigate access barriers among AGYW. Thus, the goal of this study is to evaluate the Malkia
Klabu (“Queen Club”) implementation strategy in Tanzania, a loyalty program designed for and by AGYW that
creates youth-friendly pharmacies where AGYW can access HIV prevention and sexual and reproductive
health (SRH) services, with strong linkages to facility-based care.
Based on promising data from our pilot study, we hypothesize that the creation of a welcoming and safe
pharmacy environment through the Malkia Klabu implementation model will attract AGYW and bolster uptake
of PrEP, HIV self-testing (HIVST), and other SRH services, thereby empowering AGYW to avoid HIV and
unintended pregnancy. We have designed an innovative, 5-year implementation science study to scale and
evaluate several models of Malkia Klabu’s pharmacy-based approach for PrEP and HIVST delivery in five
research sites in Lake Zone, Tanzania using the RE-AIM framework. This research will be enhanced by
implementation science training of local researchers and policymakers to optimize Malkia Klabu and benefit
future HIV prevention strategies. We will first conduct a Type 3 Hybrid Implementation-Effectiveness study of
four pharmacy-based differentiated PrEP delivery models of Malkia Klabu in 50 pharmacies, examining
implementation outcomes before and after the addition of user cost-sharing which is essential for real-world
sustainability (Aim 1). We will examine the success of the Malkia Klabu delivery models on effective use of
PrEP among a cohort of 575 AGYW, reach of the program in a cross-sectional household survey with 750
AGYW in study areas; pharmacy exit surveys with ~200 AGYW will help describe the success of pharmacy-
based PrEP service offerings (Aim 2). A Certificate in Implementation Science coupled with seed grants for
graduates will ensure the project has lasting impact (Aim 3).
At the study’s conclusion, we will determine the strongest and most sustainable version of the Malkia Klabu
implementation strategy for pharmacy-based PrEP and HIVST delivery to AGYW, and launched an
implementation science training program to enable locally-led scaling and adaptation to reach vulnerable
AGYW across Tanzania and the Region. The project is a collaboration between Mzumbe University, Health for
a Prosperous Nation, the Tanzania Ministry of Health, and University of California (San Francisco & Berkeley).
