# Simplifying PrEP delivery: One-stop service pathway to improve PrEP care efficiency and continuation in Kenya

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2024 · $602,916

## Abstract

ABSTRACT
Maximizing access and minimizing costs of delivery are key challenges for optimizing the public health impact
of HIV pre-exposure prophylaxis (PrEP). Between January 2017 and December 2019, as part of Kenya's national
public sector PrEP roll-out, we conducted a stepped-wedge cluster-randomized pragmatic trial to catalyze scale-
up of PrEP delivery integrated in 25 public HIV clinics (The Partners Scale Up Project). We demonstrated that
PrEP can be delivered in African public health facilities using existing staff: >8000 initiated PrEP (53% women)
with reasonable continuation and high adherence among those returning. The study also highlighted major health
system barriers including lengthy visits with multiple stops (i.e., separate rooms for triage, HIV testing,
counseling, pharmacy) that burden the health system. For healthy HIV uninfected persons, long waiting at the
clinic, time away from work, and costs for getting to visits challenge persons taking PrEP. Efficient delivery
strategies could reduce costs, potentially improve client engagement and allow services to be available to a
larger number of people. In a short-term pilot study jointly funded by NIH and PEPFAR, we tested the feasibility
of one-stop PrEP provision (i.e., all PrEP services provided in a single room) at PEPFAR-supported clinics and
showed that one-stop service was feasible and highly acceptable to both PrEP users and providers. One-stop
significantly shortened wait time (>80%) without reducing provider-client contact time; PrEP initiation stayed
stable and there was suggestion of better early continuation and on-time visit attendance, indicating that one-
stop PrEP might add efficiencies to PrEP systems, without undermining quality. Building on our learning from
the randomized trial and the pilot study, we propose to conduct an effectiveness-implementation cluster-
randomized trial of one-stop to assess effectiveness to improve delivery efficiency and continuation on PrEP and
to rigorously study health system factors. We will randomize 12 public health facilities with established PrEP
programs in Western Kenya 1:1 to recruit and follow 1800 HIV-uninfected persons newly initiating PrEP to test
the effectiveness of one-stop care pathway compared to usual care pathway (Aim 1). Within the large program,
we will establish a randomly selected nested observational cohort of PrEP users (n=150, including clients who
start but discontinue) to study longitudinal HIV prevention behavior, including reasons for discontinuation and
how clients align PrEP use with HIV risk. Co-primary outcomes will be continuation and adherence quantified by
tenofovir-diphosphate levels in dried blood spots. We will use the Systems Analysis and Proctor's implementation
framework to evaluate implementation outcomes at the health system, facility, provider, and client-level (Aim 2).
Finally, we will conduct micro costing and time and motion studies to evaluate the costs and model the budget
impact an...

## Key facts

- **NIH application ID:** 10873193
- **Project number:** 5R01MH129234-03
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Elizabeth Anne BUKUSI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $602,916
- **Award type:** 5
- **Project period:** 2022-08-22 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10873193

## Citation

> US National Institutes of Health, RePORTER application 10873193, Simplifying PrEP delivery: One-stop service pathway to improve PrEP care efficiency and continuation in Kenya (5R01MH129234-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10873193. Licensed CC0.

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