Task shifting and community engagement as the keys to increasing access to modern contraception: Findings from mixed methods operational research in coastal Kenya.

RATIONALE: Kilifi County, Kenya, has a modern contraceptive prevalence of 44%, compared to the national prevalence of 61%. In 2018, the Government of Kenya and Population Services Kenya implemented a pilot project in Kilifi to improve contraceptive awareness and access. AIMS AND OBJECTIVES: The Riziki Demonstration Project task shifted contraceptive injectable and implant provision to community health extension workers (CHEWs) and supported community engagement led by community health volunteers (CHVs). This mixed methods evaluation examined the effect of Riziki on contraceptive service provision and identified drivers of the intervention's success in increasing public sector contraceptive uptake. METHOD: We obtained monthly contraceptive service provision data from DHIS2 for intervention and comparison facilities from June 2018 to July 2020. Controlled interrupted time series analyses were used to assess difference-in-differences effects on the levels and trends in service provision. Qualitative data included key informant interviews with health workers, community-based focus group discussions and contraceptive journey mapping. Topics included contraception-related shifts in the health system and social environment and changes to contraceptive accessibility and demand. RESULTS: We found positive difference-in-differences effects for levels of provision for implant (adj. ß = 7.4 per month, per facility, 95% confidence interval [CI]: 2.8-12.0) and all methods combined (adj. ß = 12.2, 95% CI: 3.0-21.3). The health system provided a legal framework and management support for the pilot. Community engagement by CHVs and CHEWs, including with men and religious leaders, bolstered supportive social norms by emphasizing birth spacing and family wellbeing. Awareness and supportive social norms were strengthened among women and their husbands through counselling that leveraged CHEW and CHV community embeddedness. CONCLUSION: Findings demonstrate the potential for task sharing combined with community engagement efforts to improve contraceptive awareness, knowledge and supply. Community engagement should include men, traditional leaders and other influencers to strengthen norms that position family planning in alignment with community values.

Characterising the HIV self-testing market in Kenya: Awareness and usage, barriers and motivators to uptake, and propensity to pay.

HIVST has a key role in ensuring countries meet their 95-95-95 goals. For HIVST to be sustainable, we should explore sharing costs with users as well as the overall experience. This research explores why a consumer would use HIVST and willingness to pay for HIVST through surveying 1,021 participants 18-35 living in Nairobi or Kisumu who were not diagnosed as HIV positive and who are not currently taking PrEP for HIV. A majority (89.8%) would pay 100 KSH and 64.7% would pay 300 KSH, at higher prices likelihood of paying dropped sharply. Price reduction or subsidization coupled with interventions to address the identified barriers may increase HIVST uptake. We identified 5 distinct groups based on willingness to pay and drivers/ barriers to HIVST uptake. These were created using dimension reduction, hierarchical clustering, and k-means analysis to group respondents. 79% of participants had ever heard of HIVST, and 24% had ever used HIVST. The 5 groups included active users, unlikely users, and three segments interested in HIVST with different barriers: need for HCP support, need for increased privacy/confidentiality, and fear of positive result/disclosure.