Global WACh

April 24, 2019

Can community pharmacies in Kenya improve early access to antenatal and HIV prevention care? Dr. Melissa Mugambi awarded NIH Diversity Award to explore feasibility

In setting with high HIV prevalence, early antenatal care (ANC) visits are vital to optimize HIV testing and prevention services to reduce maternal and pediatric mortality and morbidity.  Late ANC attendance limits timely identification and delivery of HIV prevention services including pre-exposure prophylaxis (PrEP) among pregnant women at high risk for HIV infection.  To fill this gap, researchers are looking for ways to encourage pregnant women to seek ANC early and improve maternal and child health outcomes.  In Kenya, community pharmacies, also known as drug shops or chemists, are playing an increasingly important role as sources of over-the-counter sexual and reproductive health products, including urine pregnancy tests and HIV self-testing kits. These pharmacies offer important and under-utilized access points to ANC and HIV prevention care for women and have the potential to inform a new innovative PrEP delivery model.

Dr. Melissa Mugambi (Assistant Professor, Department of Global Health, Implementation Science Program) received a National Institutes for Health (NIH) Diversity Supplement Award to lead a study on the feasibility of engaging community pharmacy providers in the distribution of pregnancy tests and subsequent referral of pregnant women to ANC, in order to promote early access to ANC and PrEP. This award is a one-year supplement nested within Global WACh’s NIH-funded PrEP Implementation for Mothers in Antenatal Care (PrIMA) study, led by Drs. Grace John-Stewart, Jared Baeten, and John Kinuthia (Kenyatta National Hospital).  The parent study aims to identify the best facility-based models of PrEP delivery in maternal-child settings in Kenya. Dr. Mugambi and her team hope to generate compelling evidence on the feasibility of leveraging community pharmacies—initial and frequently accessed healthcare access points—for promoting early ANC and HIV prevention services. Specifically, Dr. Mugambi’s study aims to address the barriers to accessing early ANC (such as uncertainty of pregnancy status through pregnancy testing and transportation costs) by bringing services closer to the community and to evaluate whether this influence pregnant women seek services earlier.

This study has translational importance on other HIV prevention services.  For example, Kenya has national repeat HIV testing guidelines during pregnancy but a common challenge to effective implementation is the timing of the woman’s first ANC visit.  If tested after 28 weeks into their pregnancy, they are not eligible for a re-test during ANC or delivery and may be lost to follow up care in the postpartum period.[1] This exposes the infants of pregnant and postpartum women to the risk of HIV transmission during pregnancy, delivery, or breastfeeding.

Understanding the feasibility of PrEP delivery in pharmacies is also of considerable importance to Kenya’s Ministry of Health, according to Dr. Kinuthia. Dr. Mugambi’s findings will provide insights into this alternative delivery model among Kenya’s ANC populations.  We look forward to sharing the outcomes next year!

[1] Rogers AJ, Weke E, Kwena Z, et al. Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study. BMC Pregnancy Childbirth. 2016;16(1):151. Published 2016 Jul 11. doi:10.1186/s12884-016-0936-6