Ortblad’s R01 project aims to solve a vexing problem: the fact that individuals at risk of exposure to HIV (the virus that causes AIDS), or who have been recently exposed to the virus, can sometimes fail to receive, or to use, medications that are available to them that can stop the virus from replicating in the body — essentially stopping it in its tracks.
This issue can arise not because of price or supply chains, but because of the very last step of the medication-procurement process: the local clinic that supplies the medication. In Kenya, HIV medications have traditionally been administered at public clinics often supported by international aid programs such as PEPFAR (the President’s Emergency Plan for AIDS Relief, established by President George W. Bush in 2003). However, the opportunity to use the more ubiquitous private pharmacies to distribute HIV prevention drugs could help reach people that do not traditionally use public clinics.
“From the formative research that we’ve done on private pharmacies, we find that we’re reaching a lot more unmarried people,” Ortblad said. “We’re reaching a lot more people below the age of 25 that are of a very different demographic than those that you see presenting for PrEP at the public clinics.”
Reaching as many people as possible is particularly crucial in Kenya, where many people that could benefit from PrEP are not using it. The percentage of HIV-positive people in Western Kenya, where Ortblad has conducted her research, is believed to be up to a quarter of the population.
First approved for use by the U.S. Food and Drug Administration (FDA) in 2012, oral PrEP medications, prescribed for HIV-negative people who are at risk of contracting HIV, were a major step forward in reducing the spread of the virus. The use of PEP (post-exposure prophylaxis) medications, designed to be taken soon after an exposure to HIV and first utilized by health care workers in the 1980s, has also helped to limit the spread of the virus. A significant breakthrough in PrEP delivery occurred in 2025 with the FDA’s approval of the twice-yearly injectable PrEP lenacapavir; Ortblad’s study focuses on improving pharmacy delivery of HIV prevention products, primarily daily oral PrEP and PEP, as other new PrEP products have limited distribution in Kenya due to supply chain shortages and high costs.
In her R01-funded project, Ortblad and Bukusi will evaluate the use of a telehealth provider, such as a remote nurse, to conduct the time-consuming steps of pharmacy PrEP/PEP delivery: HIV risk screening, PrEP/PEP counseling and HIV testing (remote nurses will guide clients through HIV self-testing). The remote nurse will also support interested clients with PrEP/PEP use via a phone texting platform between pharmacy visits.
The goal of the study is to learn whether this type of intervention increases the initiation and continuation (i.e. refilling) of PrEP or PEP medications compared to standard PrEP/PEP delivery by pharmacy providers, an outcome that could influence how governments scale up and support this novel delivery platform to decrease the spread of HIV. This type of telehealth model could be expanded to other countries, particularly in places where not enough pharmacy providers exist. According to Ortblad, this model could alleviate the strain associated with relying on private pharmacies, which often have only one provider present, to deliver PrEP/PEP with the required protocols.
“One of the biggest challenges that we found to actually delivering this model at the private pharmacies from all our pilot studies is the time that it takes pharmacy providers to conduct the counseling and the HIV testing services associated with PrEP delivery,” Ortblad said.
Ortblad first began work with her Kenyan colleagues as a result of her post-doctoral research at the University of Washington under Jared Baeten, MD, PhD, now an affiliate professor of global health at UW.
“They had done a lot of early clinical research on PrEP effectiveness” in Kenya, Ortblad said. “And they were transitioning into implementation research on how you could get people to actually use this drug. It was sort of perfect timing to come in as a postdoc and contribute to some of the projects they had in the implementation science research space. They had incredible Kenyan colleagues and collaborators, and it positioned me really nicely to build off those collaborations.”
Ortblad’s hope is that by identifying the best strategies to support the delivery of HIV prevention medications at private pharmacies, the rate of HIV infection in Kenya will decrease and the strategies identified could be scaled up in Kenya and expanded to other countries.