Reciprocal Innovation – Addressing Barriers to Adolescent PrEP in Western Kenya Using an Implementation Sciences Approach2021-03-02T19:07:20-05:00

Addressing Barriers to Adolescent PrEP in Western Kenya Using an Implementation Sciences Approach

Principal Investigator Mary A. Ott, MD MA (IU) and Edith Apondi Ogalo MMED (MTRH)
International Collaborator(s) Juddy Wachira, PhD
Project Title Implementation of Adolescent PrEP in Western Kenya
Priority Area Access to healthcare; Prevention
The Intervention Adolescents and young adults have the highest rates of new HIV infections in both Kenya and the US, but have the least access to evidence-based biomedical prevention technologies, like oral pre-exposure prophylaxis (PrEP). While formal Kenya Ministry of Health and WHO policies provide a pathway for youth access to PrEP, adolescent PrEP uptake is poor. We are conducting a two-phase study to improve uptake. In Phase 1, we conducted qualitative individual interviews and focus groups on adolescent PrEP uptake and acceptability with the following groups: health care providers at Rafiki clinic and MCH, youth using PrEP, youth at elevated behavioral risk, and youth in social or community setting. These interviews followed an implementation sciences conceptual framework, Exploration, Preparation, Implementation, and Sustainment (EPIS) to capture where PrEP barriers and facilitators influence implementation of PrEP access for youth. In phase 2, we are creating an intervention based upon qualitative data in phase 1
Key Facilitators Key findings from phase 1 qualitative interviews highlighted the role of stigma and misinformation. Of importance, many young people received their information about PrEP from other youth in the community, and a key component of stigma was the belief that PrEP is for “other people” (higher risk individuals), thus youth are reluctant to seek PrEP. A key difference between PrEP users and non-users was that PrEP users perceived that PrEP was for all youth. A stigma focused intervention in phase 2 will need to target youth in community settings, to provide accurate information, and to build the belief that PrEP is for all youth.
Target Population Youth
Process to Implementation Phase 1 qualitative from Kenya will be used to inform an intervention to expand PrEP uptake and acceptability. We selected a peer navigator intervention because phase 1 interviews highlighted the need to address stigma, misinformation and access at the community level. Phase 2 will develop the peer navigator intervention and pilot it in Western Kenya. If the pilot demonstrates that this intervention is feasible and acceptable, we will more formally scale it up and test it.
Key Stakeholders Groups with an interest in improving PrEP uptake include health care providers, healthcare systems, Ministry of Health, youth-serving professionals, and youth themselves.
Scaled or Transferred? If demonstrated to be feasible and acceptable, we will more formally test and scale the intervention.
Type of Research Phase 1 qualitative interviews used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation sciences framework. Interviews and brief surveys assessed barriers and facilitators to PrEP uptake, and ideas to improve access. Outer barriers and facilitators (e.g. misinformation in community settings, stigma) were most important to participants. Phase 2 will use these preliminary data to design and pilot a peer navigator intervention.
Published Materials Phase 1 manuscript in progress
Year Funded 2018

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