Table 2.
Anticipated relative advantages of pharmacy-based versus clinic-based PrEP delivery
| Advantage | Beneficiary | Illustrative quote | |
|---|---|---|---|
| Proximal advantages | |||
| Convenience | PrEP clients | (A) | Ubiquity: “The beauty is that pharmacies are all over. I could be walking [back to work] from lunch and decide to pass by a pharmacy [to] get my PrEP.” (Kiambu PrEP Provider 10) |
| (B) | Fast service time: “[At the pharmacy,] you can take like 20 minutes, and you are out, rather than going to queue for the whole day [at a hospital].” (Kisumu Pharmacy Client 6) | ||
| (C) | Long opening hours: “You can go to the pharmacy any time because some even work up to midnight. So it [getting PrEP at the pharmacy] wouldn’t disrupt you from your work, unlike the hospital, which closes at 5 pm.” (Kiambu PrEP Client 5) | ||
| (D) | Open weekends: “In the hospital, you might go [to get PrEP] on a Friday, and they tell you, ‘No, we stopped giving [PrEP] at 1 PM. Come back on Monday’…[But] at the chemist, you will get the drugs even if it is on a Sunday. There’s no limit on the days.” (Kiambu PrEP Client 8) | ||
| (E) | Low/no transportation cost: “[With pharmacy PrEP], you don’t have to travel to the hospital to get PrEP. It is just readily available near where you live, so you would be able to save the [transportation] cost.” (Kiambu PrEP Provider 4) | ||
| Privacy | PrEP clients | (F) | “There are people who would be afraid of being seen at the [HIV] clinic [when getting PrEP] … The advantage [of pharmacy PrEP] is that there is no stigma. No one knows which medicine you are getting there [at the pharmacy].” (Kiambu PrEP Client 2) |
| (G) | Choice of location/care provider: “[I would] prefer going to a person [pharmacy provider] that doesn’t know me … So I would go to a distant chemist where I will be comfortable.” (Kiambu PrEP Client 8) | ||
| Autonomy | PrEP clients | (H) | Choice of care timing: “Here [with pharmacy PrEP] is also what we call ‘time efficiency’ because if you decide to walk to this pharmacy and see that it is crowded and you are in a hurry, you have the authority to move to the next pharmacy.” (Kiambu PrEP provider 10) |
| Profit | Pharmacies | (I) | “[PrEP] can be a source of income to the pharmacy.” (Kisumu Pharmacy Provider 6) |
| Distal advantages | |||
| Expanded access | PrEP clients | (J) | “[Pharmacy PrEP] could be a better option, especially for those [clients] who cannot reach the bigger hospitals where PrEP is available.” (Kisumu Pharmacy Client 13) |
| Increased uptake | PrEP clients | (K) | “I think it [pharmacy PrEP] would improve PrEP uptake in our country because it would remove the barriers [to clinic-based PrEP], especially for adolescents and male populations who feel more comfortable going [to pharmacies] to buy [PrEP].” (Kiambu PrEP Provider 10) |
| Increased adherence | PrEP clients | (L) | “[Pharmacy PrEP] would improve adherence because sometimes people run out of PrEP and feel lazy to go all the way to the hospital or they don’t have the [transportation] fare, so they delay. But if it is [available] at the chemist, you will just go and buy because it is near.” (Kiambu PrEP Client 12) |
| (M) | “Sometimes they [PrEP clients] forget their medication and they’ve traveled far … [It would be great] if we could tell them, ‘You can walk to a nearby chemist’ and they can continue taking the medication.” (Kiambu PrEP Provider 10) | ||
| Reduced HIV incidence | Society | (N) | “If it [PrEP] is made available in pharmacies, it would really reduce the rate of [HIV] transmission … We are struggling to achieve 90-90-90 [targets] … [Pharmacy PrEP] will encourage more people to test and know their [HIV] status.” (Kiambu PrEP Provider 3) |
| Decongested clinics | PrEP clients, providers | (O) | “If we get pharmacy-based PrEP delivery services, it will relieve the work of this [PrEP] clinic very much. And it is to the advantage of those other [PrEP] patients that need a lot of time [with clinic-based PrEP providers].” (Kiambu PrEP Provider 8) |