Reciprocal Innovation – Addressing Barriers to Adolescent PrEP in Western Kenya Using an Implementation Sciences Approach2020-08-12T11:48:47-04:00

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

Principal Investigator Dr. Mary Ott
International Collaborator(s)
Project Title Addressing Barriers to Adolescent PrEP in Western Kenya Using an Implementation Sciences Approach
Priority Area Access to healthcare; chronic disease
The Intervention Although adolescents are the age group with the highest rates of new HIV infections in Kenya, they have the least access to evidence-based biomedical prevention technologies such as oral pre-exposure prophylaxis (PrEP). Among adults, PrEP has been show to effectively interrupt HIV transmission. In response to these data, the Kenyan national government has issued protocols for PrEP. However, adolescent uptake of PrEP is extremely low. Little is known about PrEP acceptability and uptake among adolescents. Existing data are from high income countries and frequently focus on social factors such as stigma and disclosure.
Key Facilitators This intervention is being piloted in Kenya with support of the public health system run by the Kenyan Ministry of Health. The Indiana CTSI is developing a program focused on reciprocal innovation that seeks to support the indentification, adaptation, implementation, and evaluation of promising interventions developed at LMIC partner sites for use in Indiana. This infrastructure provides funding and other resoruces to adapt interventions to a US context. Additional partnerships include investigators from the IU School of Medicine, Moi Teaching and Referral Hospital, Moi University, AMPATH, the University of Toronto, and Rhode Island College.
Target Population This project will focus on three populations: (1) health care providers and other stakeholders (administrators, outreach workers, etc.) who are involved in adolescent PrEP policies and access; (2) adolescents who are currently HIV negative but at high risk for HIV; and (3) adolescents starting PrEP through the Rafiki Center. Health care providers and stakeholders will be recruited from staff and administration working with the Rafiki Center of Excellence in Adolescent Health, staff and administration working with high risk youth in other AMPATH programs, and those working with high risk youth through other MTRH and Moi School of Medicine clinical programs (e.g. reproductive health, teen obstetrics). We will use the WHO definition of adolescence, 10-19 years of age. At risk youth include discordant couples, young women who are pregnant, parenting or married, and older adolescents involved in transactional sex. For discordant couples, we will start with HIV negative partners of HIV positive youth taken care of at the Rafiki Center. HIV positive patients will be given study information to provide to their partners. Young women who are pregnant, parenting or married will be recruited through the Rafiki Center and other MTRH and AMPATH programs. Older adolescents engaged in transactional sex will be recruited with the assistance of the peer outreach worker. The third group, adolescents requesting PrEP, will be enrolled through the Rafiki Center at the time of their request.
Process to Implementation This intervention has not yet been implemented in Indiana but is being piloted in Kenya. If the pilot findings show positive outcomes, potential exists to apply this intervention to low resourced clinical settings in Indiana and the US. Following identification of potential pilot sites in Indiana, this intervention could be adapted and piloted for use in the US clinical context using support from the Indiana CTSI and other health partners in Indiana, e.g. State Department of Health, IU Health, Eskenazi, and other public health centers.
Key Stakeholders There were clinical partners, including doctors, nurses, etc. that helped with the intervention, patients, Ministry of Health stakeholders. We anticipate in transferring to the US that there would need to be similar stakeholders that would need to be engaged within the health systems.
Scaled or Transferred? The aim is to work toward scaling this process into the US setting.
Type of Research Implementation science was utilized. This project uses the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation sciences framework to guide the project. We will conduct a series of stakeholders focus groups, interviews and brief surveys to assess barriers and facilitators to PrEP uptake, and ideas to improve access. These, including adolescent health care providers, adolescents in clinic and community settings, and youth workers. We will initially focus on the highest risk adolescents, including discordant partners of HIV infected adolescents, and older adolescents with behavioral risks such as transactional sex. We will identify both inner barriers and facilitators (e.g. staff training and comfort) and outer barriers and facilitators (e.g. confidentiality and stigma). We will use this understanding of barriers and facilitators to adapt the existing PrEP protocol and design an intervention to improve adolescent uptake and maintenance.
Published Materials
Year Funded

Get Involved with Indiana CTSI