- Design
- Fidelity evaluation within a stepped-wedge cluster-randomised trial
- Population
- 12 public family planning clinics in Kisumu, Kenya; 28 simulated-client visits, 1,801 exit interviews
- Primary outcome
- Delivery of core PrEP service components
- Effect
- Risk assessment 85.7%; safety assessment 42.9%; unprompted PrEP offer 28.6%
The FP Plus Project integrated oral HIV pre-exposure prophylaxis into 12 public family planning clinics in Kisumu, Kenya. To check how faithfully it was delivered, trained actors made 28 unannounced visits posing as young women starting, continuing or asking about PrEP, and 1,801 clients completed exit surveys.
Providers assessed at least one HIV risk behaviour in 86% of visits and discussed HIV prevention in all of them. At least one PrEP counselling topic was covered in 64%, a medical safety area was assessed in 43%, and PrEP was offered unprompted in 29%. Every encounter was rated respectful and non-judgemental, and 96.5% of clients said they trusted their provider.
Integration works, but the parts most easily dropped are safety checks and actively offering PrEP — the steps that make it both safe and reach the women who would not ask.
- When adding PrEP to another service, build the safety checks — kidney function, HIV test, hepatitis B — into the visit template.
- Offer PrEP actively to eligible women; most will not ask.
- Simulated-client visits are a practical way to audit what is actually delivered.
- Clients trusted family planning providers, which makes this a good route to reach young women.
Why it matters
Integrating PrEP into existing clinics is the main way to scale it, and this shows which parts slip.
Don't overread it
Only 28 simulated visits were made, so the percentages are imprecise.
The statistics, in plain English
With 28 visits, each one shifts a percentage by about 3.6 points, so 43% and 29% are rough estimates rather than precise rates.
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