{"doi":"10.1002/jia2.26468","title":"Online delivery of oral HIV pre‐ and post‐exposure prophylaxis: findings from the ePrEP Kenya pilot","abstract":"<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>The expansion of telecommunication networks and smartphones in many African countries could be leveraged to deliver HIV prevention products directly to consumers. In collaboration with a private e‐commerce platform and online pharmacy in Kenya, MYDAWA, we piloted a new model of HIV pre‐ and post‐exposure prophylaxis (PrEP/PEP) delivery.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In the ePrEP Kenya pilot (NCT05377138), individuals living in Nairobi and Mombasa Counties could complete a free telehealth visit with a remote clinician to assess eligibility for online PrEP/PEP (i.e. ≥18 years; no medical contraindications). Eligible individuals could order HIV testing services—courier delivered to clients’ choice location—for a fee of 250 KES (∼$2 USD) for self‐testing or 150 KES (∼$1 USD) for provider‐administered rapid diagnostic testing. Following confirmation of clients’ HIV‐negative status (via an uploaded test result image), free PrEP/PEP drugs from government supply were courier delivered with or separately from HIV testing services. Clients paid a delivery fee ≤149 KES (∼$1 USD) per courier visit.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From October 2022 to December 2023, we screened 2257 individuals and enrolled 1915. Most PrEP/PEP clients were men (63%, 1428/1915), ≥25 years (72%, 1631/1915) and never married (80%, 1796/1915); few had ever used PrEP (3%, 48/1915) or PEP (14%, 263/1915). At enrolment, 227 (12%) were preliminarily eligible for PrEP and 1688 (88%) for PEP. Among PrEP‐eligible clients, 89% (203/227) completed HIV testing and 92% (208/227) received PrEP; among PEP‐eligible clients, 92% (1551/1688) completed HIV testing and 92% (1549/1688) received PEP. Most PrEP/PEP clients completed HIV testing within 6 hours of their telehealth visit (53%, 927/1757) and had drugs delivered with testing services (88%, 1546/1757). Among PrEP clients eligible for follow‐up, 47% (120/256) continued PrEP and 4% (10/256) initiated PEP following PrEP discontinuation. Among PEP clients eligible for follow‐up, 7% (99/1428) repeated PEP use and 6% (83/1428) transitioned from PEP to PrEP.).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Online PrEP/PEP delivery could expand access to prevention services by reaching individuals not engaged in existing delivery platforms. The uptake of online PEP was five times greater than PrEP, underscoring an unmet demand for PEP and highlighting the potential for online pharmacies to deliver time‐sensitive PEP services.</jats:p></jats:sec>","journal":"Journal of the International AIDS Society","year":2025,"id":609819,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1567563,"name":"Paulami Naik","orcid":"0009-0008-4046-6370","position":1,"is_corresponding":false},{"id":1567564,"name":"Tabitha Kareithi","orcid":null,"position":2,"is_corresponding":false},{"id":413494,"name":"Nicholas Thuo","orcid":"0000-0002-3288-2533","position":3,"is_corresponding":false},{"id":1232443,"name":"Phelix Okello","orcid":"0009-0006-1135-8835","position":4,"is_corresponding":false},{"id":1567565,"name":"Carlos Culquichicon","orcid":null,"position":5,"is_corresponding":false},{"id":1567566,"name":"Maeve Rafferty","orcid":null,"position":6,"is_corresponding":false},{"id":1567567,"name":"Samira Abdulrashid","orcid":null,"position":7,"is_corresponding":false},{"id":1567568,"name":"Edwin Jomo","orcid":null,"position":8,"is_corresponding":false},{"id":1567569,"name":"Nicky Nyamasyo","orcid":null,"position":9,"is_corresponding":false},{"id":1567570,"name":"Tony Wood","orcid":null,"position":10,"is_corresponding":false},{"id":1567571,"name":"Rouella Mendonca","orcid":null,"position":11,"is_corresponding":false},{"id":527339,"name":"Rachel C. Malen","orcid":"0009-0006-7262-9029","position":12,"is_corresponding":false},{"id":404956,"name":"Julia C. Dettinger","orcid":"0000-0002-9130-2666","position":13,"is_corresponding":false},{"id":299045,"name":"Jillian Pintye","orcid":"0000-0003-1255-7191","position":14,"is_corresponding":false},{"id":1567572,"name":"June Mwangi","orcid":null,"position":15,"is_corresponding":false},{"id":783677,"name":"Andy Stergachis","orcid":"0000-0003-0057-6627","position":16,"is_corresponding":false},{"id":1567573,"name":"Jonah Onentia","orcid":null,"position":17,"is_corresponding":false},{"id":1567574,"name":"Kelly Curran","orcid":null,"position":18,"is_corresponding":false},{"id":572942,"name":"Melissa Latigo Mugambi","orcid":"0000-0001-8875-5528","position":19,"is_corresponding":false},{"id":1563430,"name":"Daniel Were","orcid":"0000-0002-6538-002X","position":20,"is_corresponding":false},{"id":331198,"name":"Kenneth Ngure","orcid":"0000-0002-8062-0933","position":21,"is_corresponding":false},{"id":289068,"name":"Monisha Sharma","orcid":"0000-0002-7599-1561","position":22,"is_corresponding":false},{"id":338966,"name":"Katrina F. Ortblad","orcid":"0000-0002-5675-8836","position":23,"is_corresponding":false},{"id":331196,"name":"Catherine Kiptinness","orcid":"0000-0002-2647-0196","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Online delivery of oral HIV pre‐ and post‐exposure prophylaxis: findings from the ePrEP Kenya pilot","abstract":"<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>The expansion of telecommunication networks and smartphones in many African countries could be leveraged to deliver HIV prevention products directly to consumers. In collaboration with a private e‐commerce platform and online pharmacy in Kenya, MYDAWA, we piloted a new model of HIV pre‐ and post‐exposure prophylaxis (PrEP/PEP) delivery.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>In the ePrEP Kenya pilot (NCT05377138), individuals living in Nairobi and Mombasa Counties could complete a free telehealth visit with a remote clinician to assess eligibility for online PrEP/PEP (i.e. ≥18 years; no medical contraindications). Eligible individuals could order HIV testing services—courier delivered to clients’ choice location—for a fee of 250 KES (∼$2 USD) for self‐testing or 150 KES (∼$1 USD) for provider‐administered rapid diagnostic testing. Following confirmation of clients’ HIV‐negative status (via an uploaded test result image), free PrEP/PEP drugs from government supply were courier delivered with or separately from HIV testing services. Clients paid a delivery fee ≤149 KES (∼$1 USD) per courier visit.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From October 2022 to December 2023, we screened 2257 individuals and enrolled 1915. Most PrEP/PEP clients were men (63%, 1428/1915), ≥25 years (72%, 1631/1915) and never married (80%, 1796/1915); few had ever used PrEP (3%, 48/1915) or PEP (14%, 263/1915). At enrolment, 227 (12%) were preliminarily eligible for PrEP and 1688 (88%) for PEP. Among PrEP‐eligible clients, 89% (203/227) completed HIV testing and 92% (208/227) received PrEP; among PEP‐eligible clients, 92% (1551/1688) completed HIV testing and 92% (1549/1688) received PEP. Most PrEP/PEP clients completed HIV testing within 6 hours of their telehealth visit (53%, 927/1757) and had drugs delivered with testing services (88%, 1546/1757). Among PrEP clients eligible for follow‐up, 47% (120/256) continued PrEP and 4% (10/256) initiated PEP following PrEP discontinuation. Among PEP clients eligible for follow‐up, 7% (99/1428) repeated PEP use and 6% (83/1428) transitioned from PEP to PrEP.).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Online PrEP/PEP delivery could expand access to prevention services by reaching individuals not engaged in existing delivery platforms. The uptake of online PEP was five times greater than PrEP, underscoring an unmet demand for PEP and highlighting the potential for online pharmacies to deliver time‐sensitive PEP services.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":2.0794415416798357,"endowment":2.0794415416798357,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40569864","pmcid":"PMC12231658","openalex_id":"https://openalex.org/W4411674661","authors":[],"funders":[{"funder_name":"Bill and Melinda Gates Foundation","grant_id":"INV‐037646","title":null},{"funder_name":"National Institute of Mental Health","grant_id":"R00 MH121166","title":null},{"funder_name":"National Institute of Mental Health","grant_id":"K01 MH115789","title":null},{"funder_name":"Gates Foundation","grant_id":"INV-037646","title":null},{"funder_name":"National Institutes of Health","grant_id":"3R00MH121166-06S1","title":"Peer PrEP referral + HIV self-test for PrEP initiation among young Kenyan women"},{"funder_name":"National Institutes of Health","grant_id":"5K01MH115789-05","title":"Designing an Intervention to Increase Men's Linkage to Care and Prevention after HIV Self-Testing in Uganda"}],"total_grants":6,"fwci":5.7688,"citation_percentile":0.96646609,"influential_citations":0,"citation_trend":[{"year":2025,"count":6},{"year":2026,"count":1}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jia2.26468","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jia2.26468","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1002/jia2.26468","host_type":"publisher"},{"url":"https://doi.org/10.1002/jia2.26468","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40569864","host_type":"repository"},{"url":"https://doaj.org/article/2d3cc351a7b14252a45f93e83057c61d","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12231658","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12231658","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12231658?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1002/jia2.26468","host_type":""}],"fields_of_study":["HIV/AIDS Research and Interventions","Mobile Health and mHealth Applications","ICT in Developing Communities","Adolescent","Adult","Female","Humans","Male","Middle Aged","Young Adult","Administration, Oral","Anti-HIV Agents","HIV Infections","Kenya","Pilot Projects","Post-Exposure Prophylaxis","Pre-Exposure Prophylaxis","Telemedicine"],"mesh_terms":["Administration, Oral","Adolescent","Adult","Female","Humans","Kenya","Male","Middle Aged","Pilot Projects","HIV Infections","Telemedicine","Anti-HIV Agents","Young Adult","Post-Exposure Prophylaxis","Pre-Exposure Prophylaxis"],"keywords":["Medicine","Pre-exposure prophylaxis","Family medicine","Human immunodeficiency virus (HIV)","Pharmacy","Telehealth","Government (linguistics)","Test (biology)","Telemedicine","Men who have sex with men","Health care","Syphilis","Hiv Prevention","Post‐exposure Prophylaxis","Online Delivery","Pre‐exposure Prophylaxis","Differentiated Service Delivery","Hiv Self‐testing","Adult","Male","Adolescent","Anti-HIV Agents","Administration, Oral","HIV Infections","Pilot Projects","RC581-607","Middle Aged","Kenya","Young Adult","Humans","Female","Immunologic diseases. 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