Implementing long-acting injectable HIV pre-exposure prophylaxis services at private pharmacies in Kenya: Client, pharmacy provider, and key stakeholder perspectives on potential challenges and opportunities

IntroductionMaximizing the impact of new and forthcoming long-acting injectable HIV pre-exposure prophylaxis (PrEP) products will require novel delivery approaches that widen accessibility and prioritize clients needs and preferences. To understand the potential barriers and facilitators to delivering injectable PrEP via private pharmacies in Kenya, we conducted qualitative formative research. MethodsFrom July to September 2023, we interviewed pharmacy providers, pharmacy clients, and other key stakeholders of HIV service delivery in Central and Western Kenya. Our purposive sample included some providers and clients with prior experience delivering or obtaining oral PrEP at a pharmacy as part of a pilot study and some without such experience. We analyzed verbatim transcripts thematically using a combination of inductive and deductive approaches, the latter informed by the Consolidated Framework for Implementation Research (CFIR). ResultsWe interviewed 25 pharmacy clients, 16 pharmacy providers, and 9 key stakeholders. Each group was [~]50% female, and median age among clients was 25 (IQR 23-29). Overall, participants supported the idea of pharmacy-based injectable PrEP delivery. Anticipated facilitators included perceived benefits of injectable over oral PrEP; characteristics of pharmacies (e.g., long operating hours) that could fulfill clients need for accessible, fast, and private injectable PrEP services; and existing skillsets of pharmacy providers, especially those already trained on injectable contraception. Anticipated barriers included gaps in enabling policy; pharmacies lack of integration with the public health sector, such as its health information system; low client knowledge of and/or ability to pay for injectable PrEP; and pharmacy staffing and compensation structures that could disincentivize providers. ConclusionsParticipants in this study expressed cautious optimism that private pharmacies could be an effective delivery channel for injectable PrEP in Kenya. If private pharmacies facilitate access to and use of injectable PrEP, they could play a pivotal role in ending HIV as a public health threat.