# Delivery of PrEP to Key Populations in Kenya: Applying Coincidence Analysis to Determine Effective Implementation Strategies

> **NIH NIH R21** · UNIVERSITY OF SOUTH FLORIDA · 2023 · $389,527

## Abstract

Project Summary
Since 2012, pre-exposure prophylaxis (PrEP), typically delivered as a daily pill or more recently as a bimonthly
injection, has been available as a method of HIV prevention. Despite PrEP being highly effective at reducing a
person’s risk of acquiring HIV, uptake of the prevention method has been. In this study we will examine
existing programs implementing PrEP and assess which implementation strategies and contextual factors lead
to the best rates of PrEP initiation and persistence; these findings will contribute to improving PrEP delivery
and the ongoing HIV prevention efforts in Kenya. The study has two aims: Aim 1) Identify the implementation
strategies and contextual factors affecting PrEP implementation within clinical and community-based
organizations in Kenya and Aim 2) Determine the combination(s) of implementation strategies and contextual
factors that produce the most effective delivery of PrEP to populations at greatest risk of HIV acquisition. To
achieve Aim 1 we will collect and summarize data through three phases. In Phase 1 we will request aggregate
data from organizations that prescribe PrEP in Kenya to measure the study outcomes (i.e., the proportions of
eligible individuals who start PrEP and who have maintained PrEP use over 3-month and 6-month periods) and
identify preliminary variation in the implementation strategies and site-level contextual factors that may affect
PrEP implementation. In Phase 2 we will conduct quantitative surveys with staff at a subset of sites to assess
the impact of Consolidated Framework for Implementation Research (CFIR) factors and presence or absence
of implementation strategies on PrEP implementation outcomes. In Phase 3 we will complete semi-structured
interviews to gain a more detailed and nuanced understanding of implementation strategies and contextual
factors from Phase 2 responses. To achieve Aim 2 we will conduct Coincidence Analysis (CNA) to determine
the sets of implementation strategies and contextual factors leading to high proportions of eligible individuals
who both start and maintain PrEP (i.e., optimized implementation). CNA is a method of causal inference and
determines the combinations of factors that are minimally necessary or sufficient for an outcome of interest. In
this application we will examine which combinations of contextual factors and implementation strategies result
in optimized PrEP implementation. The models will be run for three outcomes based on the following:
proportion of clients who initiate PrEP; and proportion of clients continuing PrEP use after 3 and 6 months,
each of which will either be dichotomized (high vs. low) or trichotomized (high, medium, low). Additional
factors, representing differences in client populations (e.g., MSM, women, youth) will be included in the
analyses to determine whether unique sets of strategies and factors lead to optimization for different
populations.

## Key facts

- **NIH application ID:** 10700586
- **Project number:** 1R21MH133508-01
- **Recipient organization:** UNIVERSITY OF SOUTH FLORIDA
- **Principal Investigator:** DeAnne Turner
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $389,527
- **Award type:** 1
- **Project period:** 2023-09-15 → 2025-09-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10700586

## Citation

> US National Institutes of Health, RePORTER application 10700586, Delivery of PrEP to Key Populations in Kenya: Applying Coincidence Analysis to Determine Effective Implementation Strategies (1R21MH133508-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10700586. Licensed CC0.

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