Programmatic approaches for delivering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics.
Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya, to determine optimal clinic flow for PrEP integration into antenatal care (ANC) and postnatal care (PNC). A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys.
Clinics developed 2 approaches for integrating PrEP delivery within ANC/PNC: (1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or (2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (interquartile range 15–26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (interquartile range 7–15) was spent on PrEP-related risk assessment and counseling.
PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing.
*Department of Global Health, University of Washington, Seattle, WA;
†Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya;
‡Department of Epidemiology, University of Washington, Seattle, WA;
§University of Washington—Kenya, Nairobi, Kenya; and
║Department of Medicine, University of Washington, Seattle, WA.
Correspondence to: Jillian Pintye, RN, MPH, PhD, Department of Global Health, University of Washington, 325 Ninth Avenue, Box 359909, Seattle, WA 98104 (e-mail: firstname.lastname@example.org).
Supported by a grant from the United States Department of State as part of the DREAMS Innovation Challenge, managed by JSI Research & Training Institute, Inc. (JSI).
The PrEP Implementation for Young Women and Adolescents (PrIYA) Program is funded by the United States Department of State as part of the DREAMS Innovation Challenge (Grant # 37188-1088 MOD01), managed by JSI Research & Training Institute, Inc. J.P. is funded on NIH/NINR F32NR017125.
The authors have no conflicts of interest to disclose.
The opinions, findings, and conclusions stated herein are those of the authors and do not necessarily reflect those of the United States Department of State or JSI.
Received June 01, 2018
Accepted August 20, 2018