Testing Implementation Strategies to Improve Delivery of PrEP for Pregnant and Postpartum Women in Kenya (PrEPARE)

Testing Implementation Strategies to Improve Delivery of PrEP for Pregnant and Postpartum Women in Kenya

Testing Implementation Strategies to Improve Delivery of Pre-exposure Prophylaxis (PrEP) for Pregnant and Postpartum Women in Kenya (K01)

This study tests strategies for improving PrEP implementation in maternal and child health clinics using an interrupted time series.

This study aims to improve integrated delivery of PrEP to women seeking health services in maternal and child health clinics by piloting and evaluating four strategies or bundles of strategies for optimized PrEP delivery. Strategies to be tested include three packages of strategies identified by stakeholders.

An interrupted-time series design will be used; this is a quasi-experimental design that compares data before an intervention is introduced to data after the intervention is introduced, and controls for time trends. Three rounds of interrupted-time series to evaluate three PrEP optimization interventions, identified by stakeholders based on qualitative information. Each of the three rounds of interrupted-time series evaluations will include 4 facilities receiving the intervention and 4 facilities serving as an ongoing concurrent comparator group; these 4 facilities will not receive any of the packages of interventions, but will undergo the same data collection procedures.

Up to 12 facilities will be assigned one of three intervention groups (4 facilities per group). The strategies have no yet been identified but will be through other activities in the PrEPARE study.

There will be three strategies or bundles of strategies tested determined based on the qualitative information gathered in Aim 1 by stakeholders and are unknown at this time.

Proportion of women who are screened for PrEP / total women receiving antenatal or postnatal services

Proportion of women who receive all PrEP specific steps in a visit: HIV testing, HIV risk screening, PrEP counseling

Average Acceptability of Intervention Measures (AIM) score, 1 (Completely disagree) to 5 (Completely Agree) Likert scale

Average Intervention Appropriateness Measure (IAM) score, 1 (Completely disagree) to 5 (Completely Agree) Likert scale

Exit survey of clients to assess their satisfaction with services received at the facility, 1 (worse) to 4 (better) scale

Proportion of women who have >80 percent adherence to PrEP by pill count among those initially prescribed PrEP

Patient flow mapping to identify more efficient client flows with fewer transitions between physical spaces and providers

Inclusion Criteria: Women receiving Maternal and Child Health (MCH) services HCW participating in satisfaction surveys Exclusion Criteria: Unwilling or unable to provide informed consent