Health system opportunities and challenges for PrEP implementation in Kenya: A qualitative framework analysis

Area of Science:

• Public Health
• HIV Prevention Research
• Health Systems Strengthening

Background:

• Scaling up pre-exposure prophylaxis (PrEP) programs in sub-Saharan Africa necessitates effective national management strategies.
• Kenya's national PrEP program serves as a case study for evaluating health system integration and national implementation frameworks.
• Understanding alignment between national PrEP priorities and those of service providers, peer educators, and managers is crucial for program success.

Purpose of the Study:

• To explore health system considerations for the implementation of national pre-exposure prophylaxis (PrEP) programs.
• To assess the alignment of Kenya's national PrEP implementation priorities with the perspectives of key stakeholders.
• To evaluate the utility of a national implementation framework for large-scale PrEP programs.

Main Methods:

• Conducted twelve key informant interviews (KIIs) and nine focus group discussions (FGDs) with PrEP program managers, peer educators, and service providers.
• Utilized framework analysis to systematically apply Kenya's 2017 National PrEP Implementation Framework to qualitative data.
• Data collected through interviews and discussions were audio-recorded, translated, transcribed, and analyzed according to the framework's seven domains.

Main Results:

• Communication, coordination, training, and leadership were emphasized as critical for PrEP implementation by all respondents.
• Service providers and managers highlighted the need for efficient data collection, utilization, and improved resource allocation.
• Commodity security and research were less prioritized, and coordinated service delivery across sites was deemed essential for client experience.

Conclusions:

• Strong leadership, coordinated service delivery, and effective data utilization are valued by stakeholders in large-scale PrEP programs.
• Kenya's National PrEP Implementation Framework aligns well with the priorities of those delivering and managing PrEP services.
• The framework provides a comprehensive overview of health system considerations vital for successful national PrEP program implementation.