“It Reduces Stigma Now That the Service Is Under One Roof” Women and Provider Experiences on Factors Influencing Effective Integration of Oral PrEP Delivery in Family Planning Clinics in Kenya: A Qualitative Study

Abstract

Introduction

Women of childbearing age in sub-Saharan Africa continue to face a disproportionately high risk of HIV acquisition. Integrating pre-exposure prophylaxis (PrEP) into existing care platforms such as family planning (FP) services may offer a strategic opportunity to reach women at heightened risk for HIV. However, limited evidence exists on the factors influencing effective PrEP integration in FP settings.

Methods

From November 2021 to November 2023, we conducted a qualitative study nested within a programmatic stepped-wedge implementation project to integrate oral PrEP delivery in 12 real-world public health FP clinics in Kenya (the FP-Plus Project, Clinical Trials.gov: NCT04666792). Prior to the implementation phase of the FP-Plus project, FP providers received facility-based training and mentorship to build their capacity to deliver oral PrEP as part of routine care in FP clinics. We conducted in-depth interviews with providers and women accessing FP services using semi-structured interview guides informed by the consolidated framework of implementation research. Interviews were audio-recorded with permission, transcribed and translated. We analysed data using inductive and deductive thematic analysis approaches.

Results

Overall, we interviewed 48 providers offering PrEP in the FP clinics and 64 women accessing FP services. Women had a median age of 24 years (IQR, 23−30), and providers were 87% female. Overall, integration of PrEP in FP clinics was highly acceptable as it provided efficient service delivery, minimized missed opportunities, improved access to PrEP, saved time, improved privacy and reduced stigma by providing a discreet and trusted platform to access HIV prevention services. Women also expressed strong trust and confidence in FP providers to deliver PrEP services. Key reported barriers to integrating PrEP services included increased workload, physical space, frequent staff turnover, inefficient workflows, and occasional stockouts for both PrEP and FP commodities.

Conclusions

Integration of PrEP in public FP clinics in Kenya is highly acceptable to both women and providers. Women expressed high confidence and trust in FP providers to provide adequate HIV prevention care. Targeted strategies to overcome systemic barriers, such as inefficient workflows, workload and data systems, need to be defined to improve the efficiency of integrated FP and PrEP services provision.