The long last mile of access to essential medicines: A qualitative study on access barriers to HIV pre-exposure prophylaxis in Kenya and Ireland

This study examines the last mile barriers to HIV Pre-Exposure Prophylaxis (PrEP) in Kenya and Ireland, highlighting its role in reducing HIV infection among high-risk individuals. Despite PrEP's efficacy, timely access and consistent use are hindered by several obstacles. Using qualitative methods, the study involved 54 interviews (40 in Kenya and 14 in Ireland) and 4 focus group discussions in Kenya, engaging activists, healthcare providers, policymakers and gatekeepers. Fieldwork in Ireland took place online (due to the Covid-19 pandemic) while interviews and focus group discussions in Kenya took place in-person. Data were thematically and comparatively analysed on dedoose.com. Results identified similarities and differences in socio-cultural, economic, structural, and COVID-19 pandemic barriers. In Kenya, community, and healthcare provider stigma, along with infrastructural issues, were significant impediments. In Ireland, the focus on one community limited access for others. Both countries faced additional barriers due to the pandemic, such as lockdowns, movement restrictions, overwhelmed health infrastructure, and fear of contracting COVID-19 during clinic visits. Conclusions emphasise that providing free medicines does not ensure access. Overcoming barriers at the last mile requires more focus and funding, incorporating healthcare providers' and end users' perspectives to improve accessibility on the ground.