“These Girls Have a Chance to be the Future Generation of HIV Negative”: Experiences of Implementing a PrEP Programme for Adolescent Girls and Young Women in South Africa

Duby, Zoe; Bunce, Brittany; Fowler, Chantal; Jonas, Kim; Bergh, Kate; Govindasamy, Darshini; Wagner, Colleen; Mathews, Catherine

doi:10.1007/s10461-022-03750-1

Cited by 17 publications

(25 citation statements)

References 44 publications

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“…We focused on what influences prolonged breaks in PrEP use and one's decision to re-initiate or discontinue using PrEP. Little knowledge about PrEP [48], unwelcoming clinical experiences [49,50], relationship changes and increased perceived risk such as having multiple partners did influence PrEP use behaviours among AGYW interviewed [27,32,33,[51][52][53].…”

Section: Discussionmentioning

confidence: 92%

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

de Vos,

Mudzingwa,

Fynn

et al. 2023

J Int AIDS Soc.

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IntroductionAdolescent girls and young women (AGYW) face barriers that jeopardize their prevention‐effective use of daily oral pre‐exposure prophylaxis (PrEP). We sought to understand factors that influence AGYW's prolonged breaks in PrEP use, and their decisions to re‐initiate or discontinue using PrEP in the context of a community‐based adherence support intervention.MethodsIn‐depth interviews (IDIs) were conducted between December 2019 and April 2021 with purposively selected AGYW (aged 16–25) enrolled in the Community PrEP Study (CPS) in Buffalo City Metro Health District, Eastern Cape Province, South Africa. AGYW were offered monthly PrEP for 24 months at two community‐based study sites. Interview guides were informed by the Information‐Motivation‐Behavioural Skills Model, and data were analysed using illustrative code reports and a case analysis.ResultsA total of 603 participants were enrolled and initiated on PrEP in the parent study. Fifty‐three IDIs were conducted with 50 CPS participants. Findings revealed that external factors (e.g. local movement, school holidays and medication side‐effects) and social conflicts (e.g. discretion and partner mistrust) directly influenced breaks in PrEP usage. A decrease in one's self‐perception of HIV risk prolonged the duration of these “PrEP breaks.” Once PrEP refill visits were missed, some AGYW delayed returning for refills out of fear of being scolded by study staff. The differences between those participants who eventually re‐initiated PrEP and those who disengaged from PrEP use can be attributed to social support and encouragement, level of familiarity with PrEP, risk perceptions, self‐initiated discussions with staff and diminishing side effects.ConclusionsDespite implementing a community‐based PrEP delivery platform and behavioural intervention that included support for daily oral PrEP adherence and disclosure, participants struggled with consistent daily oral PrEP use. Unpredictable life events, including local movement and schooling schedules, in addition to being judged for their perceived behaviours, pose a challenge for consistent pill pick‐up for AGYW and habit formation. Long‐acting injectable PrEP may mitigate a number of these external barriers. Interventions that integrate long‐term planning skills, how to navigate existing social judgements and how to access sources of social support may further improve habit formation for PrEP use, regardless of its formulation.

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Section: Discussionmentioning

confidence: 92%

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

de Vos,

Mudzingwa,

Fynn

et al. 2023

J Int AIDS Soc.

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“…The doubling of PrEP uptake between 2020 and 2021, when PrEP became more widely available, demonstrates that there is a demand for HIV prevention, with young women aged 15-24 years being the largest PrEP user group. 56 While oral PrEP has been an important addition to the prevention package, there have been challenges to scaling up provision. 56 These have included issues relating to uptake, continuation rates, effective use, challenges with taking a daily pill, side effects and stigma, in addition to unpredictable sexual patterns among young users, and the lack of understanding of people's sexual risk periods, with the associated complexities relating to cycling on and off oral PrEP.…”

Section: Pre-exposure Prophylaxis In South Africamentioning

confidence: 99%

“…56 While oral PrEP has been an important addition to the prevention package, there have been challenges to scaling up provision. 56 These have included issues relating to uptake, continuation rates, effective use, challenges with taking a daily pill, side effects and stigma, in addition to unpredictable sexual patterns among young users, and the lack of understanding of people's sexual risk periods, with the associated complexities relating to cycling on and off oral PrEP. These all point to the need for additional PrEP options, including those that are more discreet, are less frequently dosed and, therefore, not reliant on daily adherence, and that have no systemic side effects.…”

Section: Pre-exposure Prophylaxis In South Africamentioning

confidence: 99%

Dapivirine Vaginal Ring for HIV Prevention in Women in South Africa

Gill¹,

Bekker²

2022

Infectious Diseases

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Young women remain disproportionately affected by the HIV epidemic in South Africa. Clinical trials have shown that the dapivirine vaginal ring (DVR) is safe and effective at reducing HIV infection in women. In March 2022, the South African Health Products Regulatory Authority approved the use of the DVR in women aged 18 years and older who are unable or unwilling to use oral pre-exposure prophylaxis, as an additional choice for preventing HIV in women at substantial risk. Modelling studies have suggested that the DVR could have a substantial impact if prioritized for women at substantial risk of HIV or women aged 22–29 years. The licensing of the DVR in South Africa is a milestone event that brings the first long-acting and woman-controlled HIV prevention method another step closer to reaching the people who need it. As South Africa prepares its introduction, it is critical to examine the unmet need for HIV prevention and to review the clinical trial data that led to the DVR's approval.

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“…The Joint United Nations Programme on HIV/AIDS (UNAIDS) set a goal to increase the number of people taking oral PrEP globally to three millions by 2020, yet the goal was not achieved [4]. Such slow growth rate of PrEP uptake may be caused by low perception of HIV transmission risk, stigma from healthcare providers or family/friends, or lack of social support or awareness [5–7]. One of the major barriers to PrEP uptake is the lack of access to healthcare providers who are knowledgeable about and willing to prescribe PrEP [6,8].…”

Section: Introductionmentioning

confidence: 99%

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

Kamitani

Mizuno

DeLuca

et al. 2023

Aids

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Objectives: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. Design: Systematic review and narrative synthesis. Methods: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: This review identified 16 studies published between 2018 and 2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP, and mail-in testing. Conclusions: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g. pharmacist prescribers), as well as the settings of PrEP care (i.e. telePrEP) and laboratory screening (i.e. mail-in testing) may increase PrEP access and care delivery.

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“These Girls Have a Chance to be the Future Generation of HIV Negative”: Experiences of Implementing a PrEP Programme for Adolescent Girls and Young Women in South Africa

Cited by 17 publications

References 44 publications

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

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

Dapivirine Vaginal Ring for HIV Prevention in Women in South Africa

Systematic review of alternative HIV pre-exposure prophylaxis (PrEP) care delivery models to improve PrEP services

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