Discussion
fits, HIV serodifferent couples
COLD
In this study, a differentiated model of 6-month PrEP dispensing supported with interim HIVST reduced the number of health care facility visits in half without jeopardizing PrEP continuation outcomes 1 year later. Despite fewer touch points with the health system and access to associated counseling services, participants interested in PrEP continuation 1 year following initiation continued HIV testing and adhering to PrEP at similar and noninferior rates when they had semiannual vs quarterly PrEP clinic visits. Notably, for women not in known HIV serodifferent couples, this simplified model of PrEP service delivery significantly increased PrEP adherence at 1 year compared with the standard model of PrEP dispensing.When considering scale-up of this novel PrEP service delivery model in Kenya and other settings, the potential benefits and costs of this model must be considered. Benefits include potential economic savings to the health systemAs newer, long-acting PrEP forms (eg, monthly vaginal rings, bimonthly injections) become increasingly available globally, differentiated models of daily oral PrEP delivery remain relevant and can have advantages over anticipated delivery models for long-acting PrEP forms. For example, oral PrEP does not require a cold chain and does not need to be delivered by a health care professional, potentially enabling more models of PrEP delivery that are community-based (eg, peer or courier delivery with mHealth interventions) and require less frequent clinic visits (eg, 6-month PrEP dispensing), which can be facilitated and supported with HIVST. Options for different PrEP modalities are needed so that clients have informed choices and can select the PrEP form and delivery model that fits their preferences, analogous to the different active pharmaceutical agents and delivery channels available for contraception.