Community pharmacists will now dispense HIV prevention drugs to Kenyans seeking protection from the virus’s infection. The decision was informed by a study that found doing so would significantly increase the country’s uptake of the medicine. 

Concerned about the low uptake of pre-exposure prophylaxis (PrEP), a drug taken by at-risk people before sexual contact, PharmPrEP and Kenya’s HIV agency, the National AIDS and STIs Control Programme (NASCOP), conducted a study. The study found that after training, pharmacy providers can effectively initiate and manage clients on PrEP according to national guidelines.

The study evaluated the use of pharmacies to distribute PrEP in six counties with high HIV prevalence: Kiambu, Kisumu, Migori, Homa Bay, Nairobi, and Siaya. The results showed that uptake and use of the drug increased from less than 10,000 in 2016, when the government rolled out access, to 438,003 in 2023. The increase was the result of several strategies, with the introduction of pharmacies being a key factor.

Last month, the country’s achievements were recognised at the world’s largest HIV and AIDS forum in Munich, Germany. Researchers were invited to share the country’s winning formula. 

Kenya and South Africa have led the region in increasing the number of people taking pre-exposure prophylaxis (PrEP), a medication used by HIV-negative individuals to prevent the virus. Three lead researchers from the PharmPrEP study, Dr. Katrina Ortblad from the University of Washington and Kenyan professors Elizabeth Bukusi and Kenneth Ngure, demonstrated that pharmacy providers can effectively deliver PrEP when well-trained and supported.

Nascop head Dr. Rose Wafula told the Nation Africa that PrEP, which the Centres for Disease Control and Prevention (CDC) says is 99 percent effective, is available free of charge to people who meet eligibility criteria at public facilities, mission hospitals, some private hospitals, clinics and drop-in centres (DICES), and can also be provided in the community through integrated outreaches by trained health workers. 

However, Dr. Wafula said there was a need to expand access and convenience of PrEP delivery to reach the population most in need.  “Avenues that traditionally offer PrEP, including public hospitals, are bedevilled by long wait times, lack of privacy, stigma, and understaffing. Drop-In-Centres, the clinics where those who need PrEP can pop in and pick up PrEP, also serve key populations, men who have sex with men and sex workers. DICES are challenging access for those who do not identify as a key population but are equally vulnerable to HIV infection, such as adolescent girls and young women, and this has contributed to driving the HIV pandemic,” Dr Wafula said. 

This study was conducted in response to the World Health Organisation’s (WHO) identification of additional barriers that patients faced when seeking medication from the clinic, and it recommended differentiated PrEP service delivery. “This is delivering services that adapt to people’s needs and preferences. In the Technical Working Groups, the use of pharmacies was floated.  

Dr. Patricia Ong’wen, an HIV researcher at the Johns Hopkins Affiliate, Jhpiego, and the Deputy Director of the study PharmPrEP, said: “Pharmacies can sort out the issues of privacy, distance and long waiting times because they are everywhere and they are already part of Kenyans’ health-seeking behaviour, where they buy medicines.”  

The country’s regulatory framework, the number of pharmacies, and research on their effectiveness favoured the decision. Regulation in Kenya does not authorise pharmacists (degree holders) and pharmaceutical technologists (diploma graduates) to prescribe medications, but screen for HIV and other diseases and provide both prescription and over-the-counter medicines.  

As of May 2024, there were 7,425 active registered retail pharmacies in Kenya. There were 2,391 active registered pharmacists (with a Bachelor of Pharmacy degree) and 9,471 pharmaceutical technologists, adequate numbers that can serve people without worrying about queues. Kenya’s HIV prevention and treatment package is designed to ensure the safety, privacy and confidentiality of people receiving services. On these grounds alone, not all pharmacies are suitable to offer PrEP.

Dr. Ong’wen outlined the initial requirements that pharmacies must meet: The pharmacy must be registered with the Pharmacy and Poisons Board and have a valid licence. It should have at least one licensed and certified pharmacist or pharmaceutical technologist on duty during each shift to ensure that a competent professional is available to provide services.  They must also have a private room for client consultation, counselling and HIV testing. In addition, as pharmacies are commercial entities, owners and providers must demonstrate a willingness to provide these services.

Once the infrastructure is in place, NASCOP and PharmPrEP ensure patient safety by training pharmacy providers to counsel clients on how to use PrEP, who is eligible and ineligible to take it, how to test for HIV, and how to prescribe and dispense PrEP by national guidelines. The training followed a pathway: Pharmacists completed three online courses on PrEP, post-exposure prophylaxis (PEP), and HIV testing at their own pace; if they passed the virtual training, they qualified for a two-day in-person training to reinforce and expand on the online content; and they participated in a one-day hands-on training on HIV testing and counselling supervised by trainers certified by NASCOP and the Ministry of Health. 

“The training was designed to rapidly build the capacity of pharmacy providers by updating their knowledge and skills on PrEP, PEP and HIV testing and counselling,” said Dr. Ong’wen.

 Dr. Veronicah Njambi, a pharmacist from Kiambu County, is one of the providers who received training. She said she learnt how to refer patients to health facilities for treatment if they test positive and are therefore ineligible for PrEP.  Dr. Njambi said she also appreciated having experienced clinicians on call after the training to answer questions about the patients who come to her pharmacy with unique challenges, such as other underlying conditions like kidney problems. 

 PrEP reduces the risk of contracting HIV through sex by about 99 per cent, and it is taken daily. In Kenya, the drug, which was introduced five years ago, has been targeted mainly at commercial sex workers and men who have sex with men, although others are also using it, albeit in secret.  Meanwhile, researchers have come up with another HIV prevention drug. But two longer-acting drugs have been proven effective: injectable Cabotegravir given every two months. People who are reluctant to take daily PrEP – 365 pills a year  – may reconsider if HIV can be prevented by taking just 12 pills a year.

 (Source: Daily Nation)