# Enhancing PrEP outcomes among Kenyan adolescent girls and young women with a novel pharmacy-based PrEP delivery platform

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2024 · $618,110

## Abstract

HIV incidence remains unacceptably high for adolescent girls and young women (AGYW). Pre-exposure
prophylaxis (PrEP) HIV prevention tools are promising, with tenofovir (TFV)-based daily oral PrEP and the
dapivirine vaginal ring (DPV-VR) recommended by WHO for cisgender women at-risk for HIV. Kenya is a leader
for PrEP delivery in Africa and efforts are ongoing to increase PrEP access with AGYW as a priority group. Our
team pioneered integrated PrEP delivery in family planning (FP) clinics in Kenya; yet, 40% of Kenyan women
access contraception without interfacing with facilities, including at retail pharmacies, and would be missed by
facility-based PrEP platforms. Retail pharmacies can increase options for reaching at-risk individuals with PrEP
and efforts are underway to define pathways for pharmacy-delivered PrEP in Kenya. We adapted our FP clinic-
based PrEP model and piloted PrEP delivery facilitated by nurse-navigators for AGYW seeking contraception at
pharmacies. AGYW offered daily oral PrEP frequently initiated, planned to continue use, and were willing to pay
for PrEP at pharmacies. Pill burden was a common reason for declining oral PrEP and could be addressed by
offering DPV-VR. Through close collaboration with the Kenya Ministry of Health both, national- and county-level,
we propose a cluster RCT at 20 pharmacies in Kisumu, Kenya–a region with an HIV prevalence of up to 28%
among women–to test the effectiveness of utilizing nurse-navigators at retail pharmacies to enhance AGYW
PrEP use. We will expand on our successful pilot to offer both daily oral PrEP and the DPV-VR and prospectively
ascertain PrEP outcomes (initiation, persistence, adherence) among AGYW. This effectiveness-implementation
hybrid RCT is designed to expedite translation into practice by evaluating clinical effectiveness alongside
implementation and cost outcomes. We hypothesize that combining nurse-navigators with pharmacy-based
PrEP will provide a cost-effective strategy for delivering novel HIV prevention tools to AGYW in HIV high-burden
settings. Aim 1 will determine the effect of nurse-navigators on PrEP initiation, persistence, and adherence
among AGYW seeking contraception within a pharmacy-based PrEP delivery model through a 2-arm cluster
RCT among HIV-negative AGYW at 20 retail pharmacies in Kisumu, Kenya. AGYW seeking contraception will
be offered PrEP and self-select daily oral PrEP or the DVR-VR. Primary outcomes will be proportion of AGYW
accessing contraception that initiate PrEP, persist with use at 10 mos., and adhere (quantified by TFV or DPV
hair levels). Secondary outcomes will include PrEP selection (PrEP pills vs. DPV-VR), STI incidence, and
adherence cofactors. Aim 2 will identify potential barriers and facilitators to acceptability, feasibility, and client
satisfaction of nurse-navigators and DPV-VR delivery for AGYW accessing PrEP at retail pharmacies through a
qualitative evaluation guided by Proctor et al. Aim 3 will estimate the cost-effective...

## Key facts

- **NIH application ID:** 10902090
- **Project number:** 5R01HD108041-04
- **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:** $618,110
- **Award type:** 5
- **Project period:** 2021-09-22 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10902090

## Citation

> US National Institutes of Health, RePORTER application 10902090, Enhancing PrEP outcomes among Kenyan adolescent girls and young women with a novel pharmacy-based PrEP delivery platform (5R01HD108041-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10902090. Licensed CC0.

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