Pregnant women in high HIV-burden settings such as western Kenya are at increased risk of acquiring HIV infection during pregnancy. The World Health Organization (WHO) and Ministry of Health in Kenya recommend a comprehensive HIV prevention package for pregnant women in high HIV-burden settings including oral pre-exposure prophylaxis (PrEP), STI screening and treatment, and partner testing. However, poor utilization of antenatal care limits opportunities for timely identification and delivery of HIV prevention interventions. In Kenya, community pharmacies are often the first point of contact for basic health services and an important entryway for reproductive health services. Leveraging existing structures, such as community pharmacies, can create cost-efficient opportunities for improving access to HIV prevention interventions among pregnant women. However, it is unclear which combination of interventions would best satisfy pregnant women?s needs and optimize uptake, which strategies should be used for implementation, and the cost of extending implementation of these interventions to community pharmacy settings. The overall objective of this study is to design and evaluate strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings.
In Aim 1, we propose to conduct a discrete choice experiment to quantify preferences for delivery of HIV prevention interventions (including PrEP, STI screening and treatment, and partner testing) for pregnant women in community pharmacy settings. Latent class analysis will be used to quantify women?s stated preferences and identify packages of intervention components that optimize uptake among different subgroups of women.
In Aim 2, we will identify provider- and system-level factors that might influence implementation of the optimal intervention packages and select strategies to improve implementation. Finally, in Aim 3, we will evaluate the potential costs of extending implementation of HIV prevention interventions from the clinic to community pharmacy settings under a range of different intervention packages (Aim 1) and implementation strategies (Aim 2). The proposed research aims complement my training goals in (1) community-based model design for HIV prevention intervention delivery, (2) stated-preference theory and methods and the application of discrete-choice experiments, (3) implementation science, and, in particular, implementation strategy design, and (4) advanced costing methods and their application to costing implementation strategies. Successful completion of these aims will enable me, as part of a future R01, to pilot test and assess the acceptability, feasibility, and impact of a pharmacy-based model for delivering HIV prevention interventions to pregnant women. My long-term goal is to become an independent implementation scientist and design new models of care to implement and scale HIV prevention interventions for pregnant women. Alongside outstanding expertise from an interdisciplinary mentoring team and the excellent training and research environment at The University of Washington, this career development award provides a solid foundation for me to launch my career as an independent researcher.
Community pharmacies play an important role in the health care system: they are frequently accessed and have increasing capacity to deliver HIV prevention services. In communities where the prevalence of HIV is high and access to antenatal care clinics is delayed or infrequent, there is a unique opportunity to leverage pharmacies to enhance early and sustained access to HIV prevention among pregnant women. This study will identify women?s preferences for delivery of HIV prevention services and provider-level and system-level strategies to design a new pharmacy-based model of care for pregnant women.