Table 1.
Adaptations to content in Kenyan Ministry of Health PrEP implementation guidelines (2018)[ 25 ] and to the context in which PrEP services are offered in public HIV care clinics
| Activity | Description | Description of adaptation | Nature of modification | Who participated in decision to modify | For whom the modification was made | Goal of modification |
|---|---|---|---|---|---|---|
| Creatinine testing | Creatinine testing is recommended at PrEP initiation, but absence of results should not delay PrEP initiation | No clinic did creatinine testing for all people initiating PrEP. Most clinics had some testing or no testing at all | Content modification with removal of elements |
PrEP programme managers at national level Individual health provider |
Health facility PrEP User |
Increase PrEP uptake as creatinine tests are costly and not readily available |
| Frequency of PrEP refills | PrEP medication should be issued monthly | At quarterly visits most facilities issued PrEP medication that exceeded one‐month supply | Content modification with tailoring of elements |
Individual health provider Health facility managers |
PrEP User |
Increase convenience for PrEP users Improve continuation |
| Discontinuation of PrEP | PrEP should be discontinued when HIV risk ends | PrEP is discontinued not only when there is no HIV risk but also when the PrEP user is ready to discontinue | Content modification with tailoring of elements | Individual health provider | PrEP User | Increase satisfaction among PrEP users |
| PrEP‐related health talks | Health talks on various topics are conducted at waiting bays routinely | Health facilities incorporated PrEP education in their health talks | Content modification with addition of elements | Health facility managers |
Potential PrEP users Partners of potential PrEP users |
Increase awareness about PrEP Improve PrEP uptake |
| Phone calls about scheduled appointments | Health workers routinely make phone calls to remind ART clients about their upcoming or missed appointments | Health workers included PrEP users in their list of individuals to be called | Content modification with addition of elements |
Health facility managers Individual health provider |
Health facility PrEP users |
Improve PrEP continuation at facility level Improve adherence to scheduled visits |
| PrEP agenda included in facility meetings | Health facilities routinely held meetings to discuss HIV service delivery | PrEP service delivery was included as a discussion item in routine facility meetings | Content modification with addition of elements | Health facility managers |
Health facility PrEP users |
Improve service delivery Improve uptake Improve continuation |
| Fasttrack PrEP users | People at HIV clinics queue for their services, and fasttrack very sick patients | People initiating or continuing PrEP use do not wait in queues but are fasttracked through service delivery points | Contextual modification to delivery setting |
Health facility managers Individual health provider |
PrEP users |
Reduce waiting time Reduce stigma Improve continuation Increase satisfaction |
| PrEP training by peers | On‐the‐job training by skilled peers for HIV treatment services | PrEP service delivery added as a skill to be trained by skilled peers | Content modification with addition of elements |
Health facility managers Individual health provider |
Individual health provider |
Increase number of providers able to provide PrEP services Reduce workload |
| Support groups | Support groups are held among HIV‐positive persons and their partners to discuss living positively |
PrEP incorporated in discussions held at support groups In some clinics, support groups specifically for PrEP users were set up |
Content modification with addition of elements |
Individual health provider Health facility managers |
Potential PrEP users Partners of potential PrEP users PrEP users |
Increase awareness about PrEP Improve PrEP uptake Improve PrEP continuation |
| Allow others to pick up drugs | Clients do PrEP refills in person | Health facilities allowed partners of PrEP users to pick medication for them when they could not come to the clinic | Contextual modification to format of delivery | Individual health provider | PrEP users | Improve PrEP continuation |
| PrEP delivery outside of regular clinic hours | PrEP services offered during regular hours | Some clinics offered PrEP services at nonregular clinic hours, for example, late afternoon or on days when the clinic is least busy | Contextual modification to delivery setting | Health facility managers | PrEP users |
Improve PrEP continuation Reduce waiting time Reduce stigma Increase client satisfaction |
| PrEP dispensed in clinic rooms | PrEP medication dispensed in pharmacy | A few clinics dispensed PrEP medication in the clinic rooms rather than asking clients to get served in pharmacy | Contextual modification to delivery setting | Health facility managers | PrEP users |
Improve PrEP continuation Reduce waiting time Reduce stigma Increase client satisfaction |
Note: Description of the modifications is guided by the FRAME: an expanded framework for reporting adaptations and modifications to evidence‐based interventions [20].