Breaking Barriers to PrEP Uptake in Kenya: Katrina Ortblad, ScD, MPH

Here, Katrina Ortblad, ScD, MPH, Cancer Prevention Program, Fred Hutch Cancer Center, addresses pre-exposure prophylaxis (PrEP) uptake barriers among young women in Kenya, an area of focus for her current research.

In part 1 of this interview, she addressed bridging gaps in HIV care.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Can you address factors that may be preventing pharmacists in all states from being able to dispense PrEP?

Unfortunately, I'm less familiar with the pharmacy-based PrEP delivery models in the United States, but I can speak toward my experience conducting work on this in Kenya. In Kenya, definitely some of the biggest barriers to pharmacies participating in this pharmacy PrEP delivery model would be licensure. They have to be licensed by the regulatory boards in Kenya in order to deliver PrEP services. They also have to have providers with certain qualifications that are willing to participate in the provider training opportunities that would enable them to deliver this model.

This model is not going to be for all pharmacies. Pharmacies are often independent operations, and while some of them might be really excited for delivering HIV prevention services, it might not be for others, for many of the reasons that you discussed. Some providers may still have HIV stigma and they maybe don't want their pharmacies to be associated with the delivery of HIV services. Some providers feel hesitant to initiate conversations about HIV prevention to clients for fear that clients might think that they perceive them a certain way. And then I think one of the other challenges for pharmacy providers is prioritizing PrEP when there's a number of other competing demands at the pharmacy, both in terms of serving clients that are coming in for other products and meeting certain daily targets that drive their business model.

What barriers to care do young women in Kenya encounter vs the US?

The barriers to PrEP among this population include lack of prep knowledge, low HIV risk perception—they don't think that they're engaged in behaviors associated with risk of HIV acquisition—they often face stigma from health care providers who don't think that these AGYW [adolescent girls and young women] should be participating in behaviors associated with HIV acquisition. They often face relationship barriers where maybe they would have challenges disclosing their PrEP use to partners for fear their partner would find their PrEP pills and that could potentially lead to conflict. They also face challenges with PrEP access, maybe not even knowing where they could go to PrEP or the hours in which PrEP is available aren't conducive with their schedules because they're in school or they work. Then they often face continued challenges with adherence and motivation to keep using PrEP.

I think many of these characteristics are sort of similar among certain populations in the US that could benefit most from PrEP. Stigma from providers, maybe lack of PrEP knowledge. I think one of the major challenges with encouraging populations to initiate PrEP sometimes is also just awareness of behaviors associated with HIV risk. A lot of people, even though they might have behaviors or they might be in a situation where they have a potential for HIV acquisition, they do not always perceive those behaviors associated with HIV risk.