{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:53:45Z","timestamp":1791568425493,"version":"4.3.4"},"reference-count":68,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1056051"],"award-info":[{"award-number":["OPP1056051"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01 MH095507"],"award-info":[{"award-number":["R01 MH095507"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In public clinics in Kenya, separate, sequential delivery of the component services of pre\u2010exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients\u2019 ability and desire to access and continue PrEP. We conducted a mixed methods study in four public clinics in western Kenya to identify strategies for operationalizing a one\u2010stop shop (OSS) model and evaluate whether this model could improve client wait time and care acceptability among clients and providers without negatively impacting uptake or continuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2020 through November 2020, we collected and analysed 47 time\u2010and\u2010motion observations using Mann\u2013Whitney U tests, 29 provider and client interviews, 68 technical assistance reports, and clinic flow maps from intervention clinics. We used controlled interrupted time series (cITS) to compare trends in PrEP initiation and on\u2010time returns from a 12\u2010month pre\u2010intervention period (January\u2013December 2019) to an 8\u2010month post\u2010period (January\u2013November 2020, excluding a 3\u2010month COVID\u201019 wash\u2010out period) at intervention and control clinics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From the pre\u2010 to post\u2010period, median client wait time at intervention clinics dropped significantly from 31 to 6 minutes (<jats:italic>p<\/jats:italic> = 0.02), while median provider contact time remained around 23 minutes (<jats:italic>p<\/jats:italic> = 0.4). Intervention clinics achieved efficiency gains by moving PrEP delivery to lower volume departments, moving steps closer together (e.g. relocating supplies; cross\u2010training and task\u2010shifting), and differentiating clients based on the subset of services needed. Clients and providers found the OSS model highly acceptable and additionally identified increased privacy, reduced stigma, and higher quality client\u2013provider interactions as benefits of the model. From the pre\u2010 to post\u2010period, average monthly initiations at intervention and control clinics increased by 6 and 2.3, respectively, and percent of expected follow\u2010up visits occurring on time decreased by 18% and 26%, respectively; cITS analysis of PrEP initiations (<jats:italic>n<\/jats:italic> = 1227) and follow\u2010up visits (<jats:italic>n<\/jats:italic> = 2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on\u2010time returns (all <jats:italic>p<\/jats:italic>&gt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An OSS model significantly improved client wait time and care acceptability without negatively impacting initiations or continuations, thus highlighting opportunities to improve the efficiency of PrEP delivery efficiency and client\u2010centredness.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25845","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T05:27:00Z","timestamp":1639373220000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A one\u2010stop shop model for improved efficiency of pre\u2010exposure prophylaxis delivery in public clinics in western Kenya: a mixed methods implementation science study"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7569-3241","authenticated-orcid":false,"given":"Stephanie D.","family":"Roche","sequence":"first","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Odoyo","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7401-3758","authenticated-orcid":false,"given":"Elizabeth","family":"Irungu","sequence":"additional","affiliation":[{"name":"Partners in Health and Research Development  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benn","family":"Kwach","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabell","family":"Dollah","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Nyerere","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Morton","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"O'Malley","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Centre for Microbiology Research Kenya Medical Research Institute  Nairobi Kenya"},{"name":"Department of Obstetrics and Gynecology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-8438","authenticated-orcid":false,"given":"Jared M.","family":"Baeten","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Department of Medicine, University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology, University of Washington Washington  Seattle USA"},{"name":"Gilead Sciences  Foster City California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth K.","family":"Mugwanya","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology, University of Washington Washington  Seattle 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