Table 4.

Determinants of feasibility of pharmacy-based PrEP delivery, organized by components of the Consolidated Framework for Implementation Research

CFIR domain	CFIR construct: Specific determinant	Illustrative quote
Intervention characteristics	Cost: Profitability	(A)	“[To make PrEP financially sustainable for pharmacies to deliver,] there must be a fee [you can charge] … Then you’ll be able to afford the space, the record-keeping, the [time and resources for client] follow-up.” (Kiambu Pharmacy Provider 6)
Inner setting	Available resources: Space	(B)	“Maybe when I open another pharmacy with more space, [I’ll deliver PrEP] … But in this pharmacy, I can’t because I only have a dispensing area … You can’t do counseling when other people are standing there [at the pharmacy counter] … You need privacy.” (Kiambu Pharmacy Provider 6)
	Available resources: Human resources	(C)	“The challenge can be if the person working [at the pharmacy] is only one … because if you are only one person who is counselling and also selling the drugs, then it becomes a challenge.” (Kisumu Pharmacy Provider 4)
	Available resources: Supplies	(D)	“[One potential challenge] is you might run out of stock of PrEP.” (Kisumu Pharmacy Provider 2)
	Compatibility: Cycle time	(E)	“Most pharmacies are very busy. [Typically,] you only give a client maybe 2 to 5 minutes. But [initiating a client on PrEP] … will take time—maybe around 30 minutes. Giving one client 30 minutes to 1 hours means you will serve less clients.” (Kiambu Pharmacy Provider 7)
	Compatibility: Documentation	(F)	“For DDA [drugs specified in the Dangerous Drugs Act], the Pharmacy and Poisons Board already requires us to keep a register with the client’s name, age, what is prescribed, number of pills, and the date … [For pharmacy PrEP,] we can keep a similar record of how we gave them PrEP.” (Kiambu Pharmacy Provider 6)
	Access to knowledge and information: Provider support tools	(G)	“[PrEP providers] have a checklist for [assessing] PrEP eligibility: the RAST [Rapid Assessment Screening Tool]. They [pharmacy PrEP providers] can use that one, too.” (Kiambu PrEP Provider 7)
Characteristics of individuals	Knowledge & Beliefs: Competency	(H)	“We [pharmacy providers] need information that will help in identifying eligible clients [for PrEP]. We need to get detailed information about side effects, how to manage, which ones to refer.” (Kiambu Pharmacy Provider 3)
	Self-efficacy: Self-efficacy	(I)	“[Say] somebody comes for HIV testing…and you did not give enough or adequate counseling, and then you hear the following day somebody has hanged himself or herself … I would be a bit worried [to do HIV testing and counseling].” (Kiambu Pharmacy Provider 5)
Outer setting	Cosmopolitanism: Networks of care	(J)	“It is important sometimes to consult further and make referrals where necessary. [For pharmacy PrEP,] we need a system that is integrated with the pharmacies that are offering PrEP so that they are networked and there are contacts.” (Kisumu Pharmacy Provider 6)