Effectiveness of pharmacy-based HIV pre- and post-exposure prophylaxis delivery: a cluster-randomized trial in Kenya
Ortblad, K. F.; Meisner, A.; Omollo, V.; Kareithi, T.; Roche, S. D.; Ongwen, P.; Asewe, M.; Anyona, M. O.; Banerjee, P.; Curran, K.; Gichuru, E.; Harkey, K.; Juma, L.; Kiptinness, C.; Malen, R. C.; Mugambi, M. L.; Otieno, P.; Pintye, J.; Rono, B.; Schaafsma, T. T.; Shah, P. D.; Sharma, M.; Thomas, K. K.; Yu, K.; Were, D.; Bukusi, E. A.; Ngure, K.
Show abstract
Private pharmacies are ubiquitous yet underutilized for HIV pre- and post-exposure prophylaxis (PrEP and PEP) delivery. In a cluster-randomized trial in Kenya (NCT05842122), we randomized 60 pharmacies 1:1:1:1 to: client-sustained delivery (~$2/visit user fee); implementor-sustained delivery (~$2/visit reimbursement); counselor-supported delivery (task shifting; ~$1/visit reimbursement); or clinic referral (control; ~$1/referral reimbursement). Commodities were supplied free to pharmacies from government stock. Primary outcomes were PrEP initiation and one-month continuation (any dispensing or refilling, respectively), self-reported by clients 60 days post-enrollment (multiple-comparisons threshold: p=0.017). From June 2023-April 2025, 5,808 clients enrolled; 64% were PEP candidates. Compared to referral, the counselor-supported arm had significantly higher PrEP initiation (RR=6.5, 95% CI [2.6, 16], p<0.001) and continuation rates (RR=5.1, 95% CI [1.4, 19], p=0.016); all intervention arms had significantly higher PEP initiation rates. One seroconversion, one social harm, and two provider needlestick injuries occurred. Pharmacy PrEP/PEP delivery outperformed clinic referral, particularly when fully subsidized and counselor-supported.
Matching journals
The top 6 journals account for 50% of the predicted probability mass.
Similar papers in this journal
- A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya 93%
- Economic evaluation of a cluster randomized, non-inferiority trial of differentiated service delivery models of HIV treatment in Zimbabwe 93%
- Evaluating the implementation of weekly rifapentine-isoniazid (3HP) for tuberculosis prevention among people living with HIV in Uganda: A qualitative evaluation of the 3HP Options Trial 92%
Similar papers in this journal
- Trends in HIV self-testing uptake in Africa: a modeling study of population-based surveys and HIV testing program data 89%
- Effectiveness of a digital clinical decision support algorithm for guiding antibiotic prescribing in pediatric outpatient care in Rwanda: A pragmatic cluster non-randomized controlled trial 89%
- Cost-effectiveness of leveraging existing HIV primary health systems and community health workers for hypertension screening and treatment in Africa: an individual-based modelling study 88%
Similar papers in this journal
- Effect of the Friendship Bench intervention on antiretroviral therapy outcomes and mental health symptoms in rural Zimbabwe: A cluster randomized trial 93%
- Health impact and cost of COVID-19 prophylaxis with monoclonal antibodies 89%
- COVID-19 cases and hospitalizations averted by case investigation and contact tracing in the United States 89%
Similar papers in this journal
- Allergic to Confounding: Leveraging Penicillin Allergy as an Instrumental Variable to Estimate the Causal Effect of Antibiotic Use on Resistance 90%
- Rapid Biphasic Decay of Intact and Defective HIV DNA Reservoir During Acute Treated HIV Disease 89%
- Peginterferon Lambda-1a for treatment of outpatients with uncomplicated COVID-19: a randomized placebo-controlled trial 89%
Similar papers in this journal
- A community-engaged mHealth intervention to increase uptake of HIV Pre-Exposure Prophylaxis (PrEP) among gay, bisexual and other men who have sex with men in China: Study protocol for a pilot randomized controlled trial 93%
- PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence): A cluster-randomized, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Program for patients with barriers to treatment 93%
- Oral Pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations 91%
"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.