title: Engaging young adult clients of community pharmacies for HIV screening in Coastal Kenya: a cross-sectional study.
abstract: BACKGROUND
  Adults in developing countries frequently use community pharmacies as the first and often only source of care. The objective of this study was to assess the success of pharmacy referrals and uptake of HIV testing by young adult clients of community pharmacies in the context of a screening programme for acute HIV-1 infection (AHI).
  
  
  METHODS
  We requested five pharmacies to refer clients meeting predefined criteria (ie, 18-29 years of age and requesting treatment for fever, diarrhoea, sexually transmitted infection (STI) symptoms or body pains) for HIV-1 testing and AHI screening at selected clinics. Using multivariable logistical regression, we determined client characteristics associated with HIV-1 test uptake.
  
  
  RESULTS
  From February through July 2013, 1490 pharmacy clients met targeting criteria (range of weekly averages across pharmacies: 4-35). Of these, 1074 (72%) accepted a referral coupon, 377 (25%) reported at a study clinic, 353 (24%) were HIV-1 tested and 127 (9%) met criteria for the AHI study. Of those tested, 14 (4.0%) were HIV-1 infected. Test uptake varied significantly by referring pharmacy and was higher for clients who presented at the pharmacy without a prescription versus those with a prescription, and for clients who sought care for STI symptoms.
  
  
  CONCLUSIONS
  About a quarter of targeted pharmacy clients took up HIV-1 testing. Clients seeking care directly at the pharmacy (ie, without a prescription) and those with STI symptoms were more likely to take up HIV-1 testing. Engagement of adult pharmacy clients for HIV-1 screening may identify undiagnosed individuals and offers opportunities for HIV-1 prevention research.
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mugo
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Henrieke A B
authors.initials: HA
authors.lastname: Prins
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Wahome
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Mwashigadi
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya.
authors.forename: Evanson
authors.initials: E
authors.lastname: Gichuru
authors.affiliation: Ministry of Health, Kilifi, Kenya.
authors.forename: Anisa
authors.initials: A
authors.lastname: Omar
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya University of Washington, Seattle, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.affiliation: Kenya Medical Research Institute, Kilifi, Kenya Oxford University, Headington, UK University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
mesh_terms: D000328:Adult; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D057220:Health Literacy; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000458:organization & administration; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*
keywords: DEVELOPING WORLD; HEALTH SERV RESEARCH; HIV TESTING; PRIMARY CARE; REFERRAL