Introduction
Differentiated models of service delivery that can decongest overcrowded clinics, can bolster self-care, and are patient-centered are needed to increase delivery efficiencies and engagement with HIV preexposure prophylaxis (PrEP) services.HIV self-testing (HIVST) is a relatively new technology that has the potential to simplify and address barriers to clinic-delivered PrEP services. For example, HIVST could be used by clients while waiting to reduce their time spent at clinicsIn this study, we tested the effect of an HIVST-supported PrEP delivery model on PrEP continuation outcomes in Kenya. Specifically, we tested a model that used HIVST to reduce the number of annual clinic visits for PrEP in half, by enabling 6-month PrEP dispensing supported with at-home HIVST between semiannual clinic visits. We hypothesized that despite the fewer touch points with the health system and associated counseling opportunities, this model of PrEP delivery would result in noninferior PrEP continuation outcomes (eg, recent HIV testing, PrEP refilling, and PrEP adherence) for clients interested in continued PrEP services 1 year later compared with the standard model of PrEP delivery with quarterly clinic visits.