Integration of pre-exposure prophylaxis services into public HIV care clinics in Kenya: a pragmatic stepped-wedge randomised trial

作者：Elizabeth Irungu, Kenneth K. Mugwanya, Nelly Mugo, Elizabeth A. Bukusi, Deborah Donnell, Josephine Odoyo, Elizabeth Wamoni, Sue Peacock, Jennifer F. Morton, Kenneth Ngure, Mary Mugambi, Irene Mukui, Gabrielle O’Malley, Jared M. Baeten · 发表于：The Lancet Global Health · 年份：2021 · DOI：10.1016/s2214-109x(21)00391-0 · 被引用次数：54 · 研究领域：HIV/AIDS Research and Interventions、Adolescent Sexual and Reproductive Health、Sex work and related issues

BACKGROUND: Successful and sustainable models for HIV pre-exposure prophylaxis (PrEP) delivery in public health systems in Africa are needed. We aimed to evaluate the implementation of PrEP delivery integrated in public HIV care clinics in Kenya. METHODS: As part of Kenya's national PrEP roll-out, we conducted a stepped-wedge cluster-randomised pragmatic trial to catalyse scale-up of PrEP delivery integrated in 25 public HIV care clinics. We selected high-volume clinics in these regions (ie, those with a high number of people living with HIV enrolled in HIV care and treatment). Clinics (each representing a cluster) were stratified by region and randomly assigned to the order in which clinic staff would receive PrEP training and ongoing technical support using numbered opaque balls picked from a bag. There was no masking. PrEP provision was done by clinic staff without additional financial support. Data were abstracted from records of individuals initiating PrEP. The primary outcome was the number of people initiating PrEP per clinic per month comparing intervention to control periods. Other outcomes included PrEP continuation, adherence, and incident HIV infections. This trial is registered with ClinicalTrials.gov, NCT03052010. FINDINGS: After the baseline period, which started in January, 2017, every month two to six HIV care clinics crossed over from control to intervention, until August, 2017, when all clinics were implementing the intervention. Of 4898 individuals initiat...