Adolescent girls and young women’s PrEP-user journey during an implementation science study in South Africa and Kenya

Rousseau, Elzette; Katz, Ariana; O’Rourke, Shannon; Bekker, Linda‐Gail; Delany‐Moretlwe, Sinead; Bukusi, Elizabeth A.; Travill, Danielle; Omollo, Victor; Morton, Jennifer; O’Malley, Gabrielle; Haberer, Jessica; Heffron, Renee; Johnson, Rachel; Celum, Connie; Baeten, Jared M.; Straten, Ariane van der

doi:10.1371/journal.pone.0258542

Cited by 80 publications

(98 citation statements)

References 46 publications

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“…Second, they call for greater engagement with AGYW in demand-creation. In agreement with observations amongst AGYW in Kenya and South Africa [ 26 ], they point towards the need to identify peers who can come forward and share their experiences of being on PrEP, and serve as role models or PrEP ambassadors. The healthcare providers also noted that they could play a more active role in identifying and recruiting AGYW to PrEP.…”

Section: Discussionsupporting

confidence: 76%

“…They also called for a disassociation of PrEP from HIV treatment. These recommendations resonate with findings from a recent qualitative study with AGYW in South Africa and Kenya, which found adolescent-friendly and integrated sexual and reproductive health services to facilitate PrEP uptake [ 26 ]. In fact, a review of early lessons from PrEP demonstration projects in SSA found PrEP initiation and impact amongst AGYW to be greater in projects that integrated PrEP into youth-friendly clinics that combined a range of different sexual and reproductive health services [ 10 ].…”

Section: Discussionsupporting

confidence: 71%

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Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

et al. 2022

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Background In sub-Saharan Africa, adolescent girls and young women (AGYW) are at high risk of acquiring HIV. A growing number of sub-Saharan African countries are beginning to avail pre-exposure prophylaxis, or PrEP, but with limited success. Unpacking strategies to overcome barriers to the uptake of PrEP is critical to prevent HIV amongst AGYW. This article explores health professionals’ views and recommendations on what is required to increase uptake of PrEP. Methods The study draws on interview data from 12 providers of HIV prevention services in eastern Zimbabwe. The healthcare providers were purposefully recruited from a mix of rural and urban health facilities offering PrEP. The interviews were transcribed and imported into NVivo 12 for thematic coding and network analysis. Results Our analysis revealed six broad strategies and 15 concrete recommendations which detail the range of elements healthcare providers consider central for facilitating engagement with PrEP. The healthcare providers called for: (1) PrEP marketing campaigns; (2) youth-friendly services or corners; (3) improved PrEP delivery mechanisms; (4) improvements in PrEP treatment; (5) greater engagement with key stakeholders, including with young people themselves; and (6) elimination of costs associated with PrEP use. These recommendations exemplify an awareness amongst healthcare providers that PrEP access is contingent on a range of factors both inside and outside of the clinical setting. Conclusions Healthcare providers are at the frontline of the HIV epidemic response. Their community-embeddedness, coupled with their interactions and encounters with AGYW, make them well positioned to articulate context-specific measures for improving access to PrEP. Importantly, the breadth of their recommendations suggests recognition of PrEP use as a complex social practice that requires integration of a combination of interventions, spanning biomedical, structural, and behavioural domains.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 71%

Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

et al. 2022

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“…Whereas the current literature on integrated PrEP-FP delivery often refers to “FP clinics” as a uniform delivery setting, our study revealed key points of heterogeneity between two FP clinics that influenced implementation (e.g., organizational mission, clinic flow). Our finding that the youth-friendly clinic was potentially “low-hanging fruit” for this HIV prevention innovation is consistent with other projects and programs in Kenya [ 6 ], South Africa [ 33 , 34 ], and Malawi [ 35 ], which similarly reported that providers at these venues were generally open to delivering PrEP and that AGYW like obtaining services in these settings. The implications of our findings for scale-up are even clearer when placed within the context of a typology of health facilities recently developed by Dunbar et al based on their assessment of 20 facilities in Kenya and Zimbabwe [ 36 ].…”

Section: Discussionsupporting

confidence: 88%

“…Studies in this first domain have measured PrEP use (e.g., uptake, adherence, continuation) and its predictors [ 5 – 7 ] and engaged AGYW to understand their PrEP decision-making [ 6 , 8 – 10 ]. Qualitative investigations have identified a variety of barriers to AGYW PrEP use, such as low HIV risk perception [ 11 – 13 ]; high stigma for being sexually active [ 14 ]; lack of financial independence [ 15 ]; and low social support for PrEP use [ 13 , 16 – 18 ]. These findings have motivated the second major area of research, centered on developing and testing delivery models and interventions to support AGYW in PrEP use.…”

Section: Introductionmentioning

confidence: 99%

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Roche

Barnabee

Omollo

et al. 2022

BMC Health Serv Res

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Introduction Across sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kisumu, Kenya. Methods From June 2017 to May 2020, the Prevention Options for Women Evaluation Research (POWER) study enrolled 1000 sexually active, HIV-negative AGYW age 16 to 25. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. We analysed data using conventional and directed content analysis, with the latter informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation. Results POWER deployed a variety of implementation strategies to train and educate stakeholders (e.g., having new providers shadow PrEP providers); develop stakeholder interrelationships (e.g., organizing support teams with protected time to reflect on implementation progress and make refinements); provide technical assistance; and change physical infrastructure and workflow. Although these strategies reportedly influenced contextual factors across four of the five CFIR domains, they primarily interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. Overall, implementing PrEP proved easier and less labor-intensive at a private, youth-friendly clinic than a public FP clinic, largely because the baseline structural characteristics (e.g., space, workflow) and organizational mission of the former were more conducive to offering AGYW-centered care. Nevertheless, adoption of PrEP delivery among non-study staff at both sites was low, likely due to the widespread perception that PrEP was not within their scope of work. Conclusions Some FP clinics may be “lower-hanging fruit” than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers’ clinical decision-making, establish worker expectations and accountability, and address workload constraints. Trial registration Clinical Trial Number: NCT03490058.

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“…In South Africa, mobile health clinics operating in locations frequented by AGYW are feasible, acceptable and improve PrEP uptake [ 25 ]. PrEP integration into sexual reproductive health services also facilitates uptake among AGYW [ 26 ]. These interventions could improve PrEP uptake among AGYW elsewhere in SSA.…”

Section: Discussionmentioning

confidence: 99%

Oral pre‐exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study

et al. 2022

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Introduction Oral pre‐exposure prophylaxis (PrEP) has been scaled up; however, data from real‐world settings are limited. We studied oral PrEP preference, uptake, adherence and continuation among adolescent girls and young women (AGYW) vulnerable to HIV in sub‐Saharan Africa. Methods We conducted a prospective cohort study among 14‐ to 24‐year‐old AGYW without HIV who were followed for 12 months in Kampala, Uganda. Within at least 14 days of enrolment, they received two education sessions, including demonstrations on five biomedical interventions that are; available (oral PrEP), will be available soon (long‐acting injectable PrEP and anti‐retroviral vaginal ring) and in development (PrEP implant and HIV vaccine). Information included mode and frequency of delivery, potential side effects and method availability. Volunteers ranked interventions, 1 = most preferred to 5 = least preferred. Oral PrEP was “preferred” if ranked among the top two choices. All were offered oral PrEP, and determinants of uptake assessed using Poisson regression with robust error variance. Adherence was assessed using plasma tenofovir levels and self‐reports. Results Between January and October 2019, 532 volunteers were screened; 285 enrolled of whom 265 received two education sessions. Mean age was 20 years (SD±2.2), 92.8% reported paid sex, 20.4% reported ≥10 sexual partners in the past 3 months, 38.5% used hormonal contraceptives, 26.9% had chlamydia, gonorrhoea and/or active syphilis. Of 265 volunteers, 47.6% preferred oral PrEP. Willingness to take PrEP was 90.2%; however, uptake was 30.6% ( n = 81). Following enrolment, 51.9% started PrEP on day 14 (same day PrEP offered), 20.9% within 30 days and 27.2% after 30 days. PrEP uptake was associated with more sexual partners in the past 3 months: 2–9 partners (aRR = 2.36, 95% CI: 1.20–4.63) and ≥10 partners (aRR 4.70, 95% CI 2.41–9.17); oral PrEP preference (aRR 1.53, 95% CI 1.08–2.19) and being separated (aRR 1.55, 95% CI 1.04–2.33). Of 100 samples from 49 volunteers during follow up, 19 had quantifiable tenofovir levels (>10 μg/L) of which only three were protective (>40 μg/L). Conclusions Half of AGYW preferred oral PrEP, uptake and adherence were low, uptake was associated with sexual behavioural risk and oral PrEP preference. Development of alternative biomedical products should be expedited to meet end‐user preferences and, community delivery promoted during restricted movement.

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Adolescent girls and young women’s PrEP-user journey during an implementation science study in South Africa and Kenya

Cited by 80 publications

References 46 publications

Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

Improving access to pre-exposure prophylaxis for adolescent girls and young women: recommendations from healthcare providers in eastern Zimbabwe

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Oral pre‐exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study

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