HIV self-tests at private pharmacies can expand PrEP access

Mr Benn Kwach

Mr Benn Kwach, site study coordinator at the Centre for Microbiology Research Kenya Medical Research Institute in Kisumu speaks to journalists in Kisumu City on October 7, 2022.

Photo credit: Francis Mureithi | Nation Media Group

High performance of blood-based HIV self-tests at private pharmacies in Kenya could be a game changer in the Pre-exposure prophylaxis (PrEP) delivery, a new study has revealed.

If the outcome of the study is approved by the relevant government agencies, it could be used as one of the testing platforms before one can initiate PrEP.

PrEP is antiretroviral medicine taken by HIV-negative individuals to prevent getting the virus.

PrEP comes as a tablet which must be taken once per day and is highly effective for preventing HIV when taken as prescribed.

Self-testing is not recognised currently as a diagnostic tool but the outcome of this study revealed that its performance is about 98 per cent like a diagnostic tool if done correctly.

The study will now be presented to the National AIDS and STI's Control Programme (NASCOP) for consideration as Pre-exposure prophylaxis (PrEP) delivery tool as an additional intervention in the fight against HIV/AIDS.

Pharmacy-based PrEP delivery has the potential to expand PrEP reach and access.

The results of the study conducted in Kisumu led by research teams which included principal investigators Prof Elizabeth Bukusi, Dr Katrina Ortblad, Prof Kenneth Ngure and Dr Daniel Were who is the Project Director were released on Tuesday during the 70th Science Media café on HIV Self-Testing organised by the Media for Environment, Science, Health and Agriculture (MESHA).

“HIV self-testing (HIVST) has the potential to support daily oral PrEP delivery in new community-based settings,” said the study.

However, guidelines have not been approved for HIVST for PrEP dispensing as there are concerns surrounding the use of HIVST for dispensing such as slightly lower sensitivity.

There are also concerns about the mistakes individuals may make during the HIVST process and misinterpretation of the HIVST results.

The study states that very few pharmacy providers are certified for Rapid Diagnostics testing (RDT) delivery.

In Kenya, pharmacy providers are permitted to deliver HIVST, but few outlets have been certified to offer these services.

According to Benn Kwach, site study Coordinator at the Centre for Microbiology Research Kenya Medical Research Institute in Kisumu at least 20 licensed pharmacies were selected for the study.

Kisumu City has an HIV prevalence of 15.6 per cent which is second nationally after Homa Bay County which stands at 16.2 per cent.

“We trained the pharmacy providers on blood-based HIVST use and client assistance,” said Mr Kwach.

The study population involved pharmacy clients above 18 years seeking services associated with HIV risk like contraception.

The sample size was 1500 clients from 40 providers and to ensure maximum efficiency data was collected electronically.

“Early pilot findings suggest that private pharmacies can reach a unique population at high HIV risk that we are not reaching with traditional clinic-delivered PrEP services,” said the study.

The study also found that Pharmacy-delivered PrEP is in high demand, with continuation rates that exceed clinic-based PrEP delivery.

However, the new delivery faces barriers to scale-up like lack of evidence on effectiveness, costs associated with delivery, and regulatory barriers surrounding HIVST.

The study concludes that the performance of provider-delivered blood-based HIVST was high at private pharmacies in Kenya compared to the national HIV testing algorithm.

The study observed that enhanced provider training and on-demand support could potentially reduce the potential for HIVST misinterpretation and further improve HIVST performance in this setting.

According to Dorothy Oketch, HIV program coordinator, Kisumu County, HIV self–testing is well-positioned to help address HIV diagnostic gaps and promote access to HIV testing services.

“HIVST increases autonomy, convenience, and privacy and is empowering,” said Ms Oketch.

A peer educator Brenda Odera said HIVST will now be taken to the doorsteps of the community.

“This service will reduce the cost of clients who don’t want to come to service providers and will also make them in charge of their lives,” said Ms Odera.