HIV Prevention & Treatment

The last two decades of global HIV work produced something extraordinary: over 20 million people on treatment, tens of millions of deaths prevented, and a generation of children born without infection. That progress was built, in large part, on a system designed for an earlier era, when HIV was an acute illness requiring more hands-on clinical management, centralized drug distribution, and close monitoring through public health facilities.

Today, the majority of people living with HIV are stable on long-term treatment. Yet service delivery models have been slow to reflect that reality, and prevention services (i.e., PrEP and PEP) have inherited many of these centralized, clinic-heavy models. Covid proved the demand and viability of bringing HIV services closer to home. Pharmacy pickup and multi-month dispensing made care more accessible while easing pressure on public facilities. But these were largely treated as added costs, rather than as opportunities to transition certain legacy programs to include pharmacy-based care.

Protecting that hard-won progress means building delivery systems which reflect what HIV looks like now, which meet patients where they are, and which use technology to improve access, lower costs, and ensure accountability.

Maisha Meds stepped into HIV treatment at a critical moment. When the USAID stop-work order cut off community access to life-saving HIV medications in Kenya, we delivered a solution that normally would have taken months — in just one week.

In January 2025, Kenya's Ministry of Health alerted us that the electronic system its national HIV program used to coordinate medication pickups at community pharmacies had gone offline, a consequence of the freeze on US foreign aid. In an instant, a pipeline connecting patients to their life-saving medications had disappeared.

What followed was a seven-day sprint that built on foundations we'd been laying for years.

• A proven platform. We were able to respond quickly because our platform was already trusted by providers, adapted across multiple health areas, and built to meet the government's rigorous reporting systems. When we received the list of pharmacies to be included in the initial launch, we discovered nearly 7 in 10 were already using Maisha Meds' point-of-sale software.
• Protecting patient privacy. Our system was designed with patient confidentiality as a core principle, with robust data protection protocols that align with local regulations. Preserving privacy while expanding access is crucial in communities where HIV stigma remains a challenge.
• Partnerships built on trust. Our relationships with NASCOP and the Ministry of Health, formalized through MOUs and strengthened through years of collaboration and data-sharing, made it possible to align and move quickly together.
• Private-sector expertise. We run our own supply chains, can integrate with public-sector supply chains, we know our clients intimately, and we process all claims transparently. Our custom-built auditing backend monitors program compliance across all health areas. Private sector is in our DNA, with a public health purpose.

The program proved so successful that, by the end of 2025, it was already expanding to new counties in Kenya, with a broader national rollout taking shape. And we're already working with health officials in other countries on how to adapt and scale this playbook elsewhere.

While our entry into HIV treatment in Kenya showed resilience in a crisis, our HIV prevention work in 2025 focused on building infrastructure proactively while strengthening connections between the public and private sectors.

Like HIV treatment, prevention tools like PrEP and PEP (pre- and post-exposure prophylaxis) are largely delivered through government systems. Community pharmacies, meanwhile, remain a preferred channel for sexual and reproductive health commodities across the region, and they may help reach people who are less likely to access HIV care through public health facilities.

We are studying our model while making it happen in real time:

• Our Kenya randomized controlled trial — conducted with KEMRI, Fred Hutch, and Jhpiego — is looking closely at how pharmacy access drives PrEP and PEP uptake and continuation. The trial concluded in 2025, and results are expected in 2026.
• An earlier pilot study in Kenya observed strong willingness among adolescent girls and young women to start, continue, and pay for PrEP at retail pharmacies — even knowing these services would be available for free at public facilities.
• Mystery shoppers rated PrEP visits with pharmacy staff as respectful, private, non-judgmental, and clearly communicated. They consistently reported that they would seek care from the same provider again.

On the implementation side, our collaboration with Uganda's Ministry of Health and the Global Fund (known as AMDIS) will support 30,000 people with pre- and post-exposure prophylaxis (PrEP and PEP) initiation and continuation. The program aims to offer patients a range of options, including pills and vaginal rings. AMDIS marks the first time publicly-funded malaria and HIV prevention commodities will flow through private pharmacies at this scale.

This is all laying the groundwork and generating real-world evidence for the next wave of HIV prevention options — including newer long-acting medicines, including injectables, that have demonstrated substantially higher effectiveness against HIV infection for people at risk. These medicines have incredible potential to change the trajectory of HIV across Africa, but only if we have the kind of last-mile delivery systems to reach the people who need it most.

Accessibility is half the challenge we're solving, and the other half is cost. We're applying what we've learned across malaria and women's health to prove that pharmacy-based HIV programs can be run at sustainable per-patient costs that are far below legacy programs.

We can deliver HIV treatment for around $10 per patient per year, and prevention for $15 (plus commodities, which vary by method). Traditional delivery benchmarks, based on PEPFAR figures and published research, run upwards of $50 per patient per year, plus commodities.