Decentralised Antiretroviral Therapy Distribution via Community Pharmacies and Viral Load Suppression in Stable Patients: A Short Report from Nairobi, Kenya

Centralised clinic-based antiretroviral therapy (ART) distribution can create access barriers and strain health systems in many African settings. Decentralising ART refills to community pharmacies is a promising differentiated service delivery model for stable patients, but evidence of its effect on clinical outcomes is limited. This short report assessed the impact of decentralising ART refills to accredited community pharmacies on viral load suppression among clinically stable patients living with HIV in Nairobi, Kenya. A retrospective cohort analysis used routine programme data. Stable adult patients on ART for at least one year with two consecutive suppressed viral loads were offered the option to collect pre-packaged ART from designated community pharmacies. Viral load suppression rates were compared between those using pharmacy distribution and a matched cohort continuing with standard clinic-based collection. Patients utilising community pharmacy distribution achieved a viral load suppression rate of 94.2%. This was non-inferior to the 93.8% suppression rate observed in the clinic-based cohort. Qualitative feedback indicated that reduced travel time and less queuing were key benefits of the decentralised model. Decentralising ART refills to accredited community pharmacies for stable patients did not compromise viral load suppression in this urban Kenyan setting. The model demonstrated feasibility and maintained high treatment success. Programme planners should consider scaling up accredited community pharmacy ART distribution as part of differentiated service delivery. Further research should assess long-term outcomes, cost-effectiveness, and feasibility in rural settings. HIV, antiretroviral therapy, task shifting, differentiated service delivery, community pharmacy, viral suppression, Kenya This report provides evidence from an African urban context supporting the clinical effectiveness of pharmacy-led ART distribution, contributing to the literature on operational models for sustainable HIV care.