{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:55:57Z","timestamp":1785390957685,"version":"3.55.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Delivery of oral pre\u2010exposure prophylaxis (PrEP) is being scaled up in Africa, but clinic\u2010level barriers including lengthy clinic visits may threaten client continuation on PrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2020 and January 2022, we conducted a quasi\u2010experimental evaluation of differentiated direct\u2010to\u2010pharmacy PrEP refill visits at four public health HIV clinics in Kenya. Two clinics implemented the intervention package, which included direct\u2010to\u2010pharmacy for PrEP refill, client HIV self\u2010testing (HIVST), client navigator, and pharmacist\u2010led rapid risk assessment and dispensing. Two other clinics with comparable size and client volume served as contemporaneous controls with the usual clinic flow. PrEP continuation was evaluated by visit attendance and pharmacy refill records, and time and motion studies were conducted to determine time spent in the clinics. Dried blood spots were collected to test for tenofovir\u2010diphosphate (TFV\u2010DP) at random visits. We used logistic regression to assess the intervention effect on PrEP continuation and the Wilcoxon rank sum test to assess the effect on clinic time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 746 clients were enrolled, 366 at control clinics (76 during pre\u2010implementation and 290 during implementation phase), and 380 at direct\u2010to\u2010pharmacy clinics (116 during pre\u2010implementation and 264 during implementation phase). Prior to implementation, the intervention and control clinics were comparable on client characteristics (female: 51% vs. 47%; median age: 33 vs. 33 years) and PrEP continuation (35% vs. 37% at 1 month, and 37% vs. 39% at 3 months). The intervention reduced total time spent at the clinic by 35% (median of 51 minutes at control vs. 33 minutes at intervention clinics; <jats:italic>p<\/jats:italic>&lt;0.001), while time spent on HIV testing (20 vs. 20 minutes; <jats:italic>p<\/jats:italic> = 0.50) and pharmacy (8 vs. 8 minutes; <jats:italic>p<\/jats:italic> = 0.8) was unchanged. PrEP continuation was higher at intervention versus the control clinics: 45% versus 33% at month 1, 34% versus 25% at month 3 and 23% versus 16% at month 6. TFV\u2010DP was detected in 85% (61\/72) of samples, similar by the study group (83% vs. 85%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A client\u2010centred PrEP delivery approach with direct\u2010to\u2010pharmacy PrEP refill visits plus client HIVST significantly reduced clinic visit time by more than one\u2010third and improved PrEP continuation in public health HIV clinics in Kenya.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26222","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T17:29:45Z","timestamp":1709746185000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effect of differentiated direct\u2010to\u2010pharmacy PrEP refill visits supported with client HIV self\u2010testing on clinic visit time and early PrEP continuation"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2999-733X","authenticated-orcid":false,"given":"Kidist Belay","family":"Zewdie","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"},{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8062-0933","authenticated-orcid":false,"given":"Kenneth","family":"Ngure","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Department of Community Health Jomo Kenyatta University of Agriculture and Technology  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Mwangi","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Maina","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Etyang","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gakuo","family":"Maina","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vallery","family":"Ogello","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmah","family":"Owidi","sequence":"additional","affiliation":[{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly R.","family":"Mugo","sequence":"additional","affiliation":[{"name":"Department of Global Health University of Washington  Seattle Washington USA"},{"name":"Partners in Health Research and Development Center for Clinical Research, Kenya Medical Research Institute  Nairobi Kenya"}],"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5208-7468","authenticated-orcid":false,"given":"Kenneth K.","family":"Mugwanya","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"},{"name":"Department of Global Health University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00056-2"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1071\/SH18090"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25276"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25866"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-020-01295-0"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-020-01880-y"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-231"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002099"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21673"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21636"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.5.21650"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-019-00437-6"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06920-4"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25619"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-021-03229-5"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003208"},{"key":"e_1_2_12_20_1","unstructured":"Kenya Ministry of Health. Kenya AIDS Strategic Framework (KASF) II 2020\/21\u20102024\/25 [Internet]. National Syndemic Disease Control Council. [cited 2023 May 27]. Available from:https:\/\/nsdcc.go.ke\/kenya\u2010aids\u2010strategic\u2010framework\u2010kasf\u2010ii\/"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25561"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002458"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000003003"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(21)00391-0"},{"key":"e_1_2_12_25_1","unstructured":"Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya [Internet]. [cited 2023 Nov 1]. Available from:https:\/\/www.prepwatch.org\/wp\u2010content\/uploads\/2016\/08\/Guidelines\u2010on\u2010ARV\u2010for\u2010Treating\u2010Preventing\u2010HIV\u2010Infections\u2010in\u2010Kenya.pdf"},{"key":"e_1_2_12_26_1","unstructured":"National AIDS & STI Control Programme.Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection in Kenya. Kenya: Ministry of Health [Internet]. 2020 [cited 2023 May 25]. Available from:https:\/\/www.nascop.or.ke\/new\u2010guidelines\/"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26137"},{"key":"e_1_2_12_28_1","unstructured":"The Comprehensive R Archive Network [Internet]. [cited 2023 Nov 1]. Available from:https:\/\/cran.rstudio.com\/"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3004006"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01710-17"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25463"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.21134"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002885"},{"key":"e_1_2_12_34_1","unstructured":"KyongoJ KiraguM KarugaR OchiengC NgunjiriA WachihiC et\u00a0al.How long will they take it? Oral pre\u2010exposure prophylaxis (PrEP) retention for female sex workers men who have sex with men and young women in a demonstration project in Kenya.Amsterdam; [cited 2023 May 27]. Available from:https:\/\/programme.aids2018.org\/Abstract\/Abstract\/8788"},{"key":"e_1_2_12_35_1","article-title":"Pre\u2010exposure prophylaxis uptake and early continuation among pregnant and post\u2010partum women within maternal and child health clinics in Kenya: results from an implementation programme","volume":"7","author":"Kinuthia J","year":"2019","journal-title":"Lancet HIV"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228620"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T04:50:53Z","timestamp":1749444653000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/jia2.26222"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26222","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26222"}}