Data_Sheet_1_Assessing young Kenyan women's willingness to engage in a peer-delivered HIV self-testing and referral model for PrEP initiation: A qualitative formative research study.docx

BackgroundPre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but uptake remains low, especially among adolescent girls and young women (AGYW) in Kenya. A model in which trained AGYW using PrEP deliver HIV self-tests to their close friends and refer them to PrEP may help increase PrEP uptake in this population. To understand AGYW's potential willingness to engage in such a model, we conducted a qualitative formative study in Kenya.MethodWe conducted semi-structured in-depth interviews (IDIs) with AGYW (16 to 24 years) in Kiambu County who were determined at risk of HIV acquisition. We purposively recruited “PrEP-naïve” (no prior PrEP use) and “PrEP-experienced” AGYW who used PrEP for at least 1 month within the previous year. We solicited perspectives on initiating/engaging in conversations about HIV risk and PrEP, distributing/receiving HIV self-test kits, and referring/following through on a referral to clinic-based HIV services. We analyzed verbatim transcripts using rapid qualitative analysis and a combination of inductive and deductive approaches, with the latter informed by the Integrated Behavior Model (IBM).ResultsFrom August to December 2020, we conducted 30 IDIs: 15 with PrEP-experienced and 15 with PrEP-naïve AGYW. Participants' median age was 20 [interquartile range (IQR): 20–22]. Overall, most participants anticipated that they would be willing to engage in this model. PrEP-experienced AGYW emphasized the salience of their concerns about friends' HIV risk behaviors, with several noting that they are already in the habit of discussing PrEP with friends. Many additionally expressed positive attitudes toward the proposed target behaviors, perceived these to be normative among AGYW, and expressed confidence in their ability to carry out the behaviors with proper support. Although few participants had HIVST experience, nearly all anticipated they would be able to use an HIV self-test kit correctly if provided instruction.ConclusionThe Kenyan AGYW who participated in this study generally anticipated that they would be willing to engage in a formal peer PrEP referral model enhanced with peer-delivered HIV self-tests. Future research is needed to pilot test this model to determine its acceptability, feasibility, and effect on HIVST and PrEP uptake within this population.</p

Receiver operating characteristic (ROC) curves for the pregnancy prediction score, individual continuous pregnancy predictors, and the multivariate model containing all predictors.

<p>Receiver operating characteristic (ROC) curves for the pregnancy prediction score, individual continuous pregnancy predictors, and the multivariate model containing all predictors.</p

The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013

<div><p>As of 2015, only 12 countries in the World Health Organization’s AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya’s efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.</p></div

Pregnancy Likelihood Scorecard.

<p>Pregnancy Likelihood Scorecard.</p

Pregnancy incidence rates by score among women in the A) Partners PrEP Study B) Partners in Prevention HSV/HIV Transmission Study at Kenyan and Ugandan sites and C) Partners Demonstration Project.

<p>Pregnancy incidence rates by score among women in the A) Partners PrEP Study B) Partners in Prevention HSV/HIV Transmission Study at Kenyan and Ugandan sites and C) Partners Demonstration Project.</p

Predictors of pregnancy in the derivation cohort.

<p>Predictors of pregnancy in the derivation cohort.</p

Under-five, infant, and neonatal mortality rates for Kenya in 1990, 2000, and 2013 (solid circles) with annual rates of reduction (ARR) for each period (solid and dashed lines) and the Millennium Development Goal (MDG) target (dotted arrow, open circle).

<p>Source: Levels and Trends in Child Mortality: Report 2015—Estimates Developed by the United Nations Inter-agency Group for Child Mortality Estimation [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0181777#pone.0181777.ref001" target="_blank">1</a>].</p

Changes in child survival indicator coverage in Kenya, 2000 and 2013*.

<p>*Estimates were not always available for years 2000 and 2013, in which case the nearest estimate between 1998 and 2003 or 2012 and 2014 was used; <b>data were not available for the three indicators showing no coverage during the 2000 time period</b>.</p> <p>^†Among all births, both inside and outside a health facility</p> <p>^‡ Children 12–23 months old who have received Bacillus Calmette-Guérin, measles and three doses each of diphtheria, pertussis, and tetanus and polio vaccine (excluding polio vaccine given at birth)</p> <p>^§Children under 5 receiving oral rehydration and continued feeding</p> <p>Source: Kenya DHS [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0181777#pone.0181777.ref029" target="_blank">29</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0181777#pone.0181777.ref030" target="_blank">30</a>] and the World Development Indicators Data Catalogue from the World Bank [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0181777#pone.0181777.ref028" target="_blank">28</a>] (accessed August 2015)</p

Key questions and themes explored during the review of national health policies and strategies, key informant interviews, and focus groups with community women that cut across child survival content areas.

<p>Key questions and themes explored during the review of national health policies and strategies, key informant interviews, and focus groups with community women that cut across child survival content areas.</p

Characteristics of key informants in Kenya.

<p>Characteristics of key informants in Kenya.</p