“I know why I am taking this pill”: Young women navigation of disclosure and support for PrEP uptake and adherence in Eastern Cape Province, South Africa

Abstract

There is limited understanding of the dynamic interplay between adolescent girl’s and young women’s (AGYW) disclosure and social support for using oral pre-exposure prophylaxis (PrEP) and adherence. Towards this, we conducted interviews with 42 AGYW enrolled in The Community PrEP Study who exhibited either high or low blood concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots. Guided by Theories of Practice, interviews and analysis focused on AGYW perspectives and experiences with PrEP disclosure, support and adherence. AGYW with high TFV-DP blood concentrations described larger social support networks and disclosure events. In contrast, those with low TFV-DP blood concentrations described disclosing to fewer people, resulting in limited social support. Participants discussed partner support, however, this support was not described as consequential to adherence, irrespective of TFV-DP levels. Those with high levels of TFV-DP in their blood described the ability to navigate social scrutiny and changes in social support, while those with low levels of TFV-DP in their blood were more likely to question their own continued use of PrEP. To facilitate AGYW’s prevention-effective use of PrEP, expanded skill-building for disclosure and resiliency against changes to social support should be examined as part of PrEP services.

High study participation but diverging adherence levels: qualitatively unpacking PrEP use among adolescent girls and young women over two years in Eastern Cape, South Africa

“…This is consistent with other PrEP studies in South Africa which reported that women who disclosed to supportive social networks had better adherence (Giovenco et al, 2021 ; O’Rourke et al, 2021 ; Stoner et al, 2021 ; Straten et al, 2014 ). We have previously reported on the role of engaging families during home visits prior to PrEP initiation as a helpful component for building family support (Medina-Marino et al, 2021a ) and the importance of disclosure for improving PrEP adherence (Daniels et al, 2021c ). Our present analysis further confirms the need for engagement with family members and social support networks from an early stage in PrEP interventions for AGYW.…”

Factors that influence adolescent girls and young women's re‐initiation or complete discontinuation from daily oral PrEP use: a qualitative study from Eastern Cape Province, South Africa

“…Together, routine disruptions and behaviour scrutiny from family, partners and friends, as well as HIV and sexual behaviour‐related stigma, negatively influenced AGYW self‐agency and ability to establish the habits needed for prevention‐effective use of PrEP [ 23 , 27 , 36 , 52 ]. Our work reveals the crucial role of supportive social networks for sustained PrEP use, including encouragement and pill reminders [ 37 ]. Given the importance of social acceptance among AGYW, peer and family‐based initiatives could prove critical for AGYW's decision to re‐initiate PrEP following breaks in use [ 11 , 21 , 36 , 52 ].…”

“…The current behavioural intervention delivered by lay‐health counsellors as either a group‐based or one‐on‐one programme, included adherence support counselling and the development of action plans for problem‐solving. Adherence was measured using TFV‐DP concentrations in DBS samples, defining high and low adherence as ≥700 versus ≤699 fmol/DBS punch [ 37 ] collected at baseline and at specific study follow‐up visits [ 40 ].…”

“…Although it has been argued that PrEP is under the control of its end-users, psychosocial, logistic and structural barriers outside their control impact users ability to effectively use and continue with daily oral PrEP [13,14,19,[21][22][23][24][25][26][27][28]. These include HIV-related stigma [13,14,19,21,22], social support [23][24][25][26]29], relational conflicts [26][27][28][30][31][32], adaptive use or seasons of risk [23,28,30,33,34], sexuality stigma [35][36][37], and structural and health system issues for PrEP pick-up [24,27,28,35,38,39].…”