Journal of the International AIDS Society
Fidelity of Implementation of Oral Pre-Exposure Prophylaxis for HIV in Public Family Planning Clinics in Kenya: Results From a Stepped-Wedge Cluster Randomized Trial
By Mukui IN, Urusaro S, Kinuthia J and 4 others.
Abstract
Introduction
Integrating HIV pre-exposure prophylaxis (PrEP) into family planning (FP) services offers a strategic opportunity to reach women at risk of HIV acquisition. We assessed fidelity to core components of oral PrEP delivery in real-world FP clinics in Kenya.
Methods
Data are from the FP Plus Project, a stepped-wedge cluster-randomized trial integrating oral PrEP into 12 public FP clinics in Kisumu, Kenya, where trained FP healthcare providers delivered PrEP services within routine services. Standardized unannounced client actor visits conducted between December 2021 and April 2022, and cross-sectional exit surveys conducted between July 2021 and July 2024 among FP clients were used to evaluate whether the core components of PrEP services were delivered as intended and to assess service quality. Client actors were trained on three case scripts depicting young women in different scenarios: PrEP initiation, PrEP continuation and PrEP during routine FP visits. After each unannounced visit, client actors completed checklists documenting delivery of PrEP services, including behavioural risk assessment, HIV testing, HIV prevention and PrEP counselling, safety assessment, PrEP dispensing and quality-of-care. Data were analysed descriptively.