Human Resource Challenges to Integrating HIV Pre-Exposure Prophylaxis (PrEP) into the Public Health System in Kenya: A Qualitative Study

Natasha Mack, Christina Wong, Kevin McKenna, Ansley Lemons, Jacob Odhiambo, Kawango Agot

Abstract

Extensive planning will be necessary to integrate HIV pre-exposure prophylaxis (PrEP) into public health systems. In Bondo and Kisumu, Kenya, we conducted interviews with 16 district and provincial public health stakeholders and held consultations with 18 provincial and 23 national public health stakeholders on topics related to PrEP rollout. We coded interview transcripts and created memos summarizing responses. We documented consultation discussions through note taking. Human resource challenges identified included increased workload and insufficient personnel, the need for task shifting/sharing, training needs, infrastructural requirements, discrimination and stigma by staff towards at-risk clients, and providers’ personal priorities about offering PrEP. These challenges paralleled current challenges related to integration of antiretroviral therapy (ART) and could be partially addressed prior to PrEP rollout. The recommendations for training staff are likewise grounded in lessons from ART and have practical application for program planners developing training curricula for PrEP delivery. (Afr J Reprod Health 2015; 19[1]: 54-62).

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Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010;363(27):2587-99. 2. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012;367(5):423-34. 3. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. The New England journal of medicine 2012;367(5):399-410. 4. CDC. Update to Interim Guidance for Preexposure Prophylaxis (PrEP) for the Prevention of HIV Infection: PrEP for Injecting Drug Users, 2013. 5. World Health Organization. Task Shifting: Rational Redistribution of Tasks among Health Workforce Teams: Global Recommendations and Guidelines, 2008. 6. Kober K, Van Damme W. Scaling up access to antiretroviral treatment in southern Africa: who will do the job? Lancet 2004;364(9428):103-7. 7. Kasper J, Bajunirwe F. Brain drain in sub-Saharan Africa: contributing factors, potential remedies and the role of academic medical centres. Archives of disease in childhood 2012;97(11):973-9. 8. Kollar E, Buyx A. Ethics and policy of medical brain drain: a review. Swiss medical weekly 2013;143:w13845. 9. Sieleunou I. Health worker migration and universal health care in Sub-Saharan Africa. The Pan African medical journal 2011;10:55. 10. Serour GI. Healthcare workers and the brain drain. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2009;106(2):175-8. 11. Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in subSaharan Africa. International journal of environmental research and public health 2007;4(2):93-100. 12. Beaglehole R, Sanders D, Dal Poz M. The public health workforce in sub-Saharan Africa: challenges and opportunities. Ethnicity & disease 2003;13(2 Suppl 2):S24-30. 13. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 2010;329(5996):1168-74. 14. Winestone LE, Bukusi EA, Cohen CR, Kwaro D, Schmidt NC, Turan JM. Acceptability and feasibility of integration of HIV care services into antenatal clinics

in rural Kenya: a qualitative provider interview study. Global public health 2012;7(2):149-63. 15. Mutemwa R, Mayhew S, Colombini M, Busza J, Kivunaga J, Ndwiga C. Experiences of health care providers with integrated HIV and reproductive health services in Kenya: a qualitative study. BMC Health Serv Res 2013;13:18. 16. Sprague C, Chersich MF, Black V. Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry. AIDS Res Ther 2011;8:10. 17. van der Doef M, Mbazzi FB, Verhoeven C. Job conditions, job satisfaction, somatic complaints and burnout among East African nurses. J Clin Nurs 2012;21(11-12):1763-75. 18. Van Damme W, Kober K, Kegels G. Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: how will health systems adapt? Soc Sci Med 2008;66(10):2108-21. 19. Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2013;16(1):18588. 20. Hontelez JA, Newell ML, Bland RM, Munnelly K, Lessells RJ, Barnighausen T. Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study. Hum Resour Health 2012;10(1):39. 21. Hirschhorn LR, Oguda L, Fullem A, Dreesch N, Wilson P. Estimating health workforce needs for antiretroviral therapy in resource-limited settings. Hum Resour Health 2006;4:1. 22. Barnighausen T, Bloom DE, Humair S. Human resources for treating HIV/AIDS: needs, capacities, and gaps. AIDS Patient Care STDS 2007;21(11):799-812. 23. WHO. Addressing Africa's health workforce crisis: An avenue for action: WHO, 2004. 24. Kolars JC, Cahill K, Donkor P, Kaaya E, Lawson A, Serwadda D, et al. Perspective: partnering for medical education in Sub-Saharan Africa: seeking the evidence for effective collaborations. Acad Med 2012;87(2):216-20. 25. Chang LW, Serwadda D, Quinn TC, Wawer MJ, Gray RH, Reynolds SJ. Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects. The Lancet infectious diseases 2013;13(1):65-76. 26. Maddison AR, Schlech WF. Will universal access to antiretroviral therapy ever be possible? The health care worker challenge. The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 2010;21(1):e64-9. 27. Bogart LM, Chetty S, Giddy J, Sypek A, Sticklor L, Walensky RP, et al. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS Care 2013;25(7):843-53.

Mack et al. HR Challenges to Integrating PrEP

African Journal of Reproductive Health March 2015; 19 (1): 62

Reis C, Heisler M, Amowitz LL, Moreland RS, Mafeni JO, Anyamele C, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med 2005;2(8):e246. 29. Duff P, Kipp W, Wild TC, Rubaale T, Okech-Ojony J. Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda. J Int AIDS Soc 2010;13:37. 30. Painter TM, Diaby KL, Matia DM, Lin LS, Sibailly TS, Kouassi MK, et al. Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study. BMJ 2004;329(7465):543. 31. Varga C, Brookes H. Factors influencing teen mothers' enrollment and participation in prevention of motherto-child HIV transmission services in Limpopo Province, South Africa. Qual Health Res 2008;18(6):786-802. 32. Katz MH. Pre-exposure prophylaxis for HIV: can it be implemented in the real world? American journal of preventive medicine 2013;44(1 Suppl 2):S161-2. 33. Zachariah R, Van Damme W, Arendt V, Schmit JC, Harries AD. The HIV/AIDS epidemic in sub-Saharan Africa: thinking ahead on programmatic tasks and related operational research. J Int AIDS Soc 2011;14 Suppl 1:S7. 34. Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg 2009;103(6):549-58. 35. Wheelock A, Eisingerich AB, Gomez GB, Gray E, Dybul MR, Piot P. Views of policymakers, healthcare

workers and NGOs on HIV pre-exposure prophylaxis (PrEP): a multinational qualitative study. BMJ open 2012;2(4). 36. Brown GF, Raghavendran V, Walker S. Planning for Microbicide Access in Developing Countries: Lessons from the Introduction of Contraceptive Technologies: International Partnership for Microbicides, 2007. 37. Hankins CA, Dybul MR. The promise of pre-exposure prophylaxis with antiretroviral drugs to prevent HIV transmission: a review. Current opinion in HIV and AIDS 2013;8(1):50-8. 38. Tripathi A, Ogbuanu C, Monger M, Gibson JJ, Duffus WA. Preexposure prophylaxis for HIV infection: healthcare providers' knowledge, perception, and willingness to adopt future implementation in the southern US. South Med J 2012;105(4):199-206. 39. Arnold EA, Hazelton P, Lane T, Christopoulos KA, Galindo GR, Steward WT, et al. A qualitative study of provider thoughts on implementing pre-exposure prophylaxis (PrEP) in clinical settings to prevent HIV infection. PLoS One 2012;7(7):e40603. 40. White JM, Mimiaga MJ, Krakower DS, Mayer KH. Evolution of Massachusetts physician attitudes, knowledge, and experience regarding the use of antiretrovirals for HIV prevention. AIDS Patient Care STDS 2012;26(7):395-405. 41. Tellalian D, Maznavi K, Bredeek UF, Hardy WD. PreExposure Prophylaxis (PrEP) for HIV Infection: Results of a Survey of HIV Healthcare Providers Evaluating Their Knowledge, Attitudes, and Prescribing Practices. AIDS Patient Care STDS 2013. 42. Krakower D, Mayer KH. Engaging healthcare providers to implement HIV pre-exposure prophylaxis. Curr Opin HIV AIDS 2012;7(6):593-9.

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