Kipkurui Nicholas, RN

Willingness of young women to test and initiate post-exposure prophylaxis while seeking emergency contraceptive pills in pharmacies in Kenya

Nicholas Kipkurui1, 3, Dorothy Oketch2, Scholastica Wanjiru1, Gerald Owuor3, 1, Elizabeth Bukusi4, Kawango Agot1, 3, Alison Roxby5

1. Impact Research and Development Organization, Kisumu -Kenya 
2. Afya Research Africa-Kisumu -Kenya
3. Reducing HIV in Adolescents and Youth (RHAY) Kisumu -Kenya
4.Kenya Medical Research Institute, Nairobi -Kenya
5.University of Washington-Seattle USA

Adolescent girls and young women (AGYW) seeking emergency contraceptive pills (ECP) aim to prevent conception following unprotected sex. Condomless sex with persons of unknown HIV status also increases the risk of HIV acquisition. HIV screening is a vital step for prevention and treatment while post-exposure prophylaxis (PEP) is effective in lowering the risk of HIV acquisition after exposure. Pharmacies, where most AGYWs purchase ECP, can serve as convenient outreach points for HIV prevention services including PEP. We set out to assess the willingness of AGYW seeking ECP to test for HIV and initiate PEP in pharmacies.

We enrolled AGYW aged 15-24 from May to August 2023 seeking ECP in 4 participating pharmacies in Kisumu and Nairobi County, Kenya. We trained pharmacy providers on research ethics, documentation, screening, and consenting. Participants were surveyed via REDCap at two points; baseline and 10-day follow-up. Baseline data captured socio-demographics, use of ECP, HIV risk perception, HIV testing history, willingness to test for HIV, and willingness to initiate PEP; follow-up assessed whether participants had engaged in PEP or HIV testing. The pharmacy attendants informed on the option for a follow-up survey, issued participants with an information sheet on HIV testing and PEP services, and referred those interested to public health facilities. Data was summarized using frequency distribution, a measure of central tendency, and 95% confidence intervals.

We screened 300 and enrolled 200 AGYW; mean age is 21.6 years; 47.8% are dating, 50.8% were single, 42.1% and 48.0% had secondary and post-secondary education, respectively. ECP use was high: 50.7% were first time users while 49.2 reported more than three times year. Perceived HIV risk was generally high with 42.4% reporting high risk, medium risk at 22.6%, with only 34.9% reporting low risk. 36.0% had gone for an HIV test three months before the study, and 17.3%, in six months, and 52.0% more than six months pre-study. A majority (95.6%) showed interest in pharmacy-based HIV testing; with 92.6% showing interest in initiating PEP alongside ECP use as they understood the connection between the 2 risks. On follow-up, (52, 68.4%), opted to purchase HIV self-test at the pharmacy and (19, 25.0%) linked to public hospitals for HIV testing and PEP. (74, 49.3%) didn’t link for any services citing; (15, 20.3%) felt was not at risk, (8, 10.8%) fear knowing HIV status, (14, 18.9%) Did have time, (15, 20.3%) Still planning to go for testing.

The findings show that ECP users at pharmacies perceive themselves to be at risk for HIV and are interested in additional services. Enhancing the capacity of pharmacies to provide comprehensive HIV prevention services, including HIV testing and PEP initiation can significantly improve access to HIV services among at-risk AGYW.