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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study
Journal of the International AIDS Society, Volume 26, No. 10, Article e26177, Year 2023
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Description
Introduction: HIV self-testing (HIVST) has the potential to support daily oral pre-exposure prophylaxis (PrEP) delivery in private pharmacies, but many national guidelines have not approved HIVST for PrEP dispensing. In Kenya, pharmacy providers are permitted to deliver HIVST, but often do not have the required certification to deliver rapid diagnostic testing (RDT). We estimated the performance of provider-delivered HIVST compared to RDT, the standard of care for PrEP delivery, at private pharmacies in Kenya to inform decisions on the use of HIVST for PrEP scale-up. Methods: At 20 pharmacies in Kisumu County, we trained pharmacy providers (pharmacists and pharmaceutical technologists) on blood-based HIVST use and client assistance (if requested). We recruited pharmacy clients purchasing sexual and reproductive health-related products (e.g. condoms) and enrolled those ≥18 years with self-reported behaviours associated with HIV risk. Enrolled clients received HIVST with associated provider counselling, followed by RDT by a certified HIV testing services (HTS) counsellor. Pharmacy providers and clients independently interpreted HIVST results prior to RDT (results interpreted only by the HTS counsellor). We calculated the sensitivity and specificity of pharmacy provider-delivered HIVST compared to HTS counsellor-administered RDT. Results: Between March and June 2022, we screened 1691 clients and enrolled 1500; 64% (954/1500) were female and the median age was 26 years (IQR 22–31). We additionally enrolled 40 providers; 42% (17/40) were pharmacy owners and their median years of experience was 6 (IQR 4–10). The majority (79%, 1190/1500) of clients requested provider assistance with HIVST and providers spent a median of 20 minutes (IQR 15–43) with each HIVST client. The sensitivity of provider-delivered HIVST at the pharmacy was high when interpreted by providers (98.5%, 95% CI 97.8%, 99.1%) and clients (98.8%, 95% CI 98.0%, 99.3%), as was the specificity of HIVST in this setting (provider-interpretation: 96.9%, 95% CI 89.2%, 99.6%; client-interpretation: 93.8%, 95% CI 84.8%, 98.3%). Conclusions: When compared to the national HIV testing algorithm, provider-delivered blood-based HIVST at private pharmacies in Kenya performed well. These findings suggest that blood-based HIVST may be a useful tool to support PrEP initiation and continuation at private pharmacies and potentially other community-based delivery settings. © 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.
Authors & Co-Authors
Ortblad, Katrina F.
United States, Seattle
Fred Hutchinson Cancer Center
Kwach, Benn
Kenya, Nairobi
Kenya Medical Research Institute
Asewe, Magdaline
Kenya, Nairobi
Kenya Medical Research Institute
Ong’wen, Patricia Atieno
United States, Baltimore
Jhpiego Corporation
Malen, Rachel C.
United States, Seattle
Fred Hutchinson Cancer Center
Odoyo, Josephine B.
Kenya, Nairobi
Kenya Medical Research Institute
Sharma, Monisha
United States, Seattle
University of Washington
Were, Daniel Knight
United States, Baltimore
Jhpiego Corporation
Ngure, Kenneth K.
Kenya, Nairobi
Jomo Kenyatta University of Agriculture and Technology
Omollo, Victor
Kenya, Nairobi
Kenya Medical Research Institute
Bukusi, Elizabeth Anne
Kenya, Nairobi
Kenya Medical Research Institute
United States, Seattle
University of Washington
Statistics
Citations: 2
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1002/jia2.26177
ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Kenya
Participants Gender
Female