Facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) uptake through a community-based intervention strategy among adolescent girls and young women in Seme Sub-County, Kisumu, Kenya

Abstract

Background While the introduction of HIV Pre-Exposure Prophylaxis (PrEP) as an HIV prevention strategy has allowed women to exercise more control over the reduction of HIV transmission rates, adolescent girls and young women in Sub-Saharan Africa continue to experience higher rates of HIV infections and bear the greatest disease burden. Understanding progress in PrEP uptake among adolescent girls and young women would enhance risk reduction in this vulnerable population. The Determined, Resilient, AIDS-Free, Mentored and Safe women (DREAMS) Initiative plays a key role in this risk reduction strategy. Methods We performed a qualitative study to explore facilitators and barriers to PrEP implementation and assess factors effecting initiation and persistence on PrEP among adolescent girls and young women enrolled in the DREAMS Initiative at Pamoja Community Based Organization in Kisumu, Kenya. We conducted key informant interviews (n = 15) with Pamoja Community Based Organization staff, health care providers and community leaders. Additionally, we conducted focus group discussions with young women receiving PrEP and peer mentors (n = 40). We performed a directed content analysis using the Consolidated Framework for Implementation Research to organize the identified facilitators and barriers. Results We found that the use of the safe space model, decentralization of PrEP support and delivery, peer mentors, effective linkage to local health care facilities, the sensitization of parents and male sexual partners, disclosure of PrEP use by beneficiaries, active stakeholder involvement and community engagement were among some of the facilitators to PrEP uptake. Barriers to PrEP implementation, initiation and persistence included stigma associated with the use of anti-retroviral drugs, drug side effects, frequent relocation of beneficiaries, limited resources for routine screening and medication monitoring, and a limited number of qualified health care workers for PrEP distribution and administration. Conclusion Overall, the community roll-out of PrEP within the DREAMS Initiative was successful due to a number of key facilitating factors, which ultimately led to successful PrEP implementation, increased PrEP initiation and enhanced persistence among adolescent girls and young women. The identified barriers should be addressed so that a larger scale-up of PrEP roll-out is possible in the future.

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

“…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 ]. Recognising their lack of financial resources and trained staff to provide timely and responsive care to AGYW, challenges also identified by healthcare providers in Kenya [ 11 ], all the healthcare providers in our study recommended further investments in the healthcare cadre involved in PrEP provision.…”

“…They also found side-effects to be an issue; albeit an issue AGYW learnt to overcome. A focus group study with AGYW in Kenya, however, found side-effects to constitute a barrier to PrEP uptake and engagement [ 11 ]. The study also noted issues related to the packaging of PrEP.…”

“…Much of this literature—quite rightly—draws on the perspectives and experiences of AGYW. This literature has identified a number of barriers to PrEP, including fears of how family, friends, partners and healthcare providers may react if they find out that an AGYW is using PrEP [ 11 – 14 ]. Studies have observed that these fears are rooted in a mix of sexuality and HIV-related stigmas [ 15 , 16 ], and intersect with gender norms and ‘good girl’ notions, forcing AGYW to choose between the social risks of stigma or the risks of HIV acquisition [ 17 ].…”

“…Studies have observed that these fears are rooted in a mix of sexuality and HIV-related stigmas [ 15 , 16 ], and intersect with gender norms and ‘good girl’ notions, forcing AGYW to choose between the social risks of stigma or the risks of HIV acquisition [ 17 ]. Also practical challenges such as distances to health facilities [ 18 ] and finding the time and resources to attend routine screening and monitoring have been noted [ 11 , 12 ]. More recently, a longitudinal study with AGYW in Cape Town, South Africa, has documented how intrinsic and extrinsic drivers of motivation to continue or discontinue with PrEP change over time, influenced by attitudes, practices and structures in the social fabric of AGYWs’ lives [ 19 ].…”

Provider Perspectives on Factors Affecting the PrEP Care Continuum Among Black Cisgender Women in the Midwest United States: Applying the Consolidated Framework for Implementation Research

“…A separate study identified barriers and facilitators affecting the PrEP care continuum in Kenya among girls and young women by conducting key informant interviews with staff, providers, and medical leaders; results highlight the importance of using a safe space model, peer mentors, including parents and partners in PrEP education, and active stakeholder involvement. 19…”