This study tests strategies for improving PrEP implementation in maternal and child health clinics using an interrupted time series.
This study aims to improve integrated delivery of PrEP to women seeking health services in maternal and child health clinics by piloting and evaluating four strategies or bundles of strategies for optimized PrEP delivery. Strategies to be tested include three packages of strategies identified by stakeholders.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
5,173
There were three bundles of strategies tested determined based on the qualitative information gathered in Aim 1 by stakeholders
Ober Health Center
Homa Bay, Kenya
Change in PrEP Penetration
Proportion of women who are screened for PrEP / total women receiving antenatal or postnatal services
Time frame: 6 months
Change in PrEP Fidelity
Proportion of women who receive all PrEP specific steps in a visit: HIV testing, HIV risk screening, PrEP counseling. Assessed among the subset of women who are due for an HIV test, as per Kenyan guidelines, which is a subset of the overall sample.
Time frame: 6 months
Timeliness of Services
Time (minutes) spent receiving services from health care workers
Time frame: 6 months
Waiting Time
Time (minutes) spent waiting to receive services
Time frame: 6 months
HCW Acceptability
Total on 4 item Acceptability of Intervention Measures (AIM) score, 1 (Completely disagree) to 5 (Completely Agree) Likert scale. The minimum score on the 4 items is 4 points (scoring 1 on each of the 4 items) while the maximum is 20 points (scoring 5 on each of the 4 items). A higher score indicates a better outcome. The sub-scores on each of the 4 items are summed.
Time frame: 6 months
Health Care Worker (HCW) Appropriateness
Total on 4 item Intervention Appropriateness Measure (IAM) score, 1 (Completely disagree) to 5 (Completely Agree) Likert scale. The minimum score on the 4 items is 4 points (scoring 1 on each of the 4 items) while the maximum is 20 points (scoring 5 on each of the 4 items). A higher score indicates a better outcome. The sub-scores on each of the 4 items are summed.
Time frame: 6 months
Client Satisfaction
Total on 7 item exit survey of clients to assess their satisfaction with services received at the facility, 1 (worse) to 4 (better) scale. The minimum score on the 7 items is 7 points (scoring 1 on each of the 7 items) while the maximum is 24 points (scoring 4 on each of the 7 items). A higher score indicates a better outcome. The sub-scores on each of the 4 items are summed.
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Time frame: 6 months
PrEP Uptake
Proportion of women who accept PrEP among those offered
Time frame: 6 months
PrEP Continuation
Proportion of women who present for a refill among those initially prescribed PrEP
Time frame: 6 months
Client PrEP Knowledge
Number of participants with perfect knowledge on PrEP information questions based on content covered in counseling sessions
Time frame: 6 months
PrEP Adherence
Proportion of women who have \>80 percent adherence to PrEP by pill count among those initially prescribed PrEP
Time frame: 6 months
PrEP Efficiency
Patient flow mapping to identify more efficient client flows with fewer transitions between physical spaces and providers
Time frame: 6 months