Anticipated Determinants and Strategies Supporting Same-Day HIV Preexposure Prophylaxis Implementation During Emergency Care Encounters in Kenya: A Qualitative Study.

BACKGROUND

Same-day HIV preexposure prophylaxis (PrEP) implementation remains challenging, especially in high-volume settings such as emergency departments (EDs). To guide program design and implementation efforts, we qualitatively explored anticipated implementation determinants and accompanying strategies facilitating same-day PrEP implementation in an urban Kenyan ED.

METHODS

In 2024-2025, we conducted a cross-sectional qualitative study involving key informant interviews (N = 20) with physicians, nurses, pharmacists, HIV counselors, and administrators at Kenyatta National Hospital in Nairobi, Kenya. Using the Consolidated Framework for Implementation Research (CFIR), we explored theorized determinants of ED-based PrEP implementation and subsequently mapped identified determinants to requisite implementation strategies, articulated in the Expert Recommendations for Implementing Change (ERIC) taxonomy, using a CFIR-ERIC matching approach.

RESULTS

The most salient barriers to same-day, ED-based PrEP implementation emerged within the Inner Setting domain, including space limitations, staffing shortages, and suboptimal capacity and provider competency to deliver PrEP in emergency care settings. Some providers perceived HIV services and emergency care as incongruous, impeding integration of PrEP into ED-based clinical workflows. Anticipated patient stigma, perceived incompatibility of PrEP services with status-neutral care environments, and opaque clinical/practice guidelines also constrained ED-based PrEP implementation. Identified facilitators included existing leadership involvement in clinical decision making, existing interdepartmental collaborations, and provider enthusiasm to reach younger persons and key populations with PrEP in the ED. ERIC strategies mapping to all 5 CFIR domains included: conducting ongoing training , promoting network weaving , and tailoring strategies .

CONCLUSIONS

Findings indicate strategies such as longitudinal training, standardizing screening with integrated systems, and configuration of setting-specific guidelines/protocols may enhance same-day, ED-based PrEP programming.