PHARMA-GIRL: Empowering adolescent girls and young women with choice and prevention in pharmacy-based HIV interventions
openNICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development
ABSTRACT
Sub-Saharan Africa's (SSA) 400 million adolescent girls and young women (AGYW, age 15-24) face
disproportionate rates of HIV acquisition and suboptimal HIV care engagement. Despite the widespread
availability of oral PrEP at public health facilities, uptake is impeded by low awareness, socio-cultural and access
barriers, provider bias, and user dissatisfaction. Moreover, among PrEP-aware AGYW, uptake and continuation
of PrEP is low due to side effects, fear of being seen with medicines, and low adherence support, undermining
PrEP's preventative effects and leaving AGYW in need of critical HIV prevention. Our team and others have
demonstrated that AGYW are interested in PrEP, especially newer modalities such as injectables, and that they
prefer to seek HIV care at locations that foster privacy, are convenient, and are girl-friendly. Given the growing
recognition that pharmacies, staffed by health workers who can be trained to provide expanded services,
outnumber health facilities, can promote beneficial health behaviors, bridge gaps in health services, and mitigate
health workforce shortages, we aim to expand this body of research to conduct an implementation science study
on potential implementation models of pharmacy-based PrEP provision and adherence support for AGYW.
In Uganda, the Community Retail Private Pharmacy Drug Distribution Point (CRPDDP) already provides
pharmacy-based anti-retroviral therapy (ART) to over 48,000 clients across 160+ pharmacies (and increasing).
Given the Uganda Ministry of Health's interest to expand this pharmacy-based differentiated service delivery
model for increased reach and extended prevention offerings, we propose a mixed-methods study to garner
foundational evidence to evaluate how this cadre of pharmacies already providing ART refills to PLHIV can
include PrEP services generally and specifically tailored to AGYW. We hypothesize that these pharmacies can
be well-equipped to reach AGYW with PrEP, given the critical role they already play in the community providing
expanded care. As such, we propose to conduct formative research among CRPDDP pharmacies and their
AGYW clients to advance implementation of pharmacy-based PrEP and adherence support. Guided by
participatory processes of human-centered design, including in-depth interviews with AGYW who are potential
PrEP users, pharmacists, and focus groups with pharmacy and youth advisory boards and MOH stakeholders,
we will conduct formative research to understand barriers, facilitators, and desires for pharmacy-based PrEP to
inform a discrete choice experiment (DCE) (Aim 1). We will then evaluate a series of implementation science
outcomes—willingness, acceptability, feasibility, and readiness—among CRPDDP pharmacists (n=~160) (Aim
2), and conduct parallel DCE surveys among CRPDDP pharmacists and their AGYW clients (n=300) to evaluate
preferences for pharmacy-based PrEP implementation models (Aim 3). By the end of the study, we will
understand how a potentially ready platform of pharmacies can be expanded to provide PrEP care to a key
population, and will have identified potential implementation gaps from user, provider, and policy perspectives .
Up to $151K
health research