Trajectories of PrEP Adherence Among Young Women Aged 16 to 25 in Cape Town, South Africa

Stoner, Marie; Rucinski, Katherine B.; Giovenco, Danielle; Gill, Katherine; Morton, Jennifer; Bekker, Linda‐Gail; Celum, Connie; Straten, Ariane van der

doi:10.1007/s10461-020-03134-3

Cited by 21 publications

(44 citation statements)

References 21 publications

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“…The study occurred in a primary healthcare setting, in a DoH-run clinic, with no financial compensation for attendance. Our results are in line with other studies showing intermittent engagement, and a large proportion of PrEP discontinuations (48.2%) occurring within the first six months [ 19 , 20 , 40 , 44 ]. Although many women did not sustain PrEP use, a minority continued to engage in PrEP services, and a significant proportion showed sustained good adherence.…”

Section: Discussionsupporting

confidence: 93%

“…For the purpose of this analysis, missing values of TFV-DP (where the participant did not attend the visit) were set to zero. This is in line with previous study [ 40 ], and based on the assumption that participants who did not attend the visit would have had low adherence levels around that point in time.…”

Section: Methodssupporting

confidence: 92%

“…Latent groups of participants with similar PrEP adherence trajectories were identified using group-based trajectory modelling [ 38 , 39 ]. Previous literature has suggested that early adherence predicts later adherence [ 16 ], and a recent study in a similar population identified two latent groups based on PrEP adherence trajectories [ 40 ]. We explored combinations of linear and quadratic models for two or three groups.…”

Section: Methodsmentioning

confidence: 99%

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Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

et al. 2021

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Daily oral pre-exposure prophylaxis (PrEP) is a key tool in addressing high HIV incidence among young women, and breaking the cycle of transmission. From 2017 to 2020, Médecins Sans Frontières (MSF) offered PrEP, in conjunction with contraception and risk-reduction counselling, to women aged 18–25, in a government-run clinic in Khayelitsha, a low income high HIV prevalence area in South Africa. Drawing on clinical, quantitative, and qualitative interview data, we describe participants’ experiences and engagement with the PrEP program, participant adherence (measured by TFV-DP levels in dried blood spots) over time, and the indirect benefits of the PrEP program. Of 224 screened and eligible participants, 164 (73.2%) initiated PrEP, with no large differences between those who initiated and those who did not. Overall, 47 (29%) completed 18 months follow-up, with 15 (9.1%) attending all visits. 76 (46.9%) participants were lost to follow-up, 15 (9.1%) exited when leaving the area, and 28.7% of exits happened in the first month of the study. We identified two different trajectories of PrEP adherence: 67% of participants had, on average, consistently low TFV-DP levels, with the remaining 33% having sustained high adherence. Few baseline characteristics predicted good adherence. The main reported barrier to taking PrEP was forgetting to take or travel with the pills. Encouragement from others declined as a reported facilitator from month 6 to 18 (family: 93.1% vs 77.6%, p = 0.016, friends: 77.6% vs 41.4%, p ≤ 0.001, partners: 62.1% vs 46.6%, p = 0.096, other PrEP users: 89.7% vs 74.1%, p = 0.020). Disclosure to friends and family in some cases opened dialogue around sex, and helped to educate others about PrEP. Self-reported sex with more than one partner, and sex without a condom, decreased significantly after enrolment (p < 0.001, p = 0.063). In the individual interviews, participants credited their PrEP experience with changing their behaviour. Recognising the challenges with, but overall benefits from a package of care that includes the option of PrEP, lessons drawn from this study can help maximise persistence on PrEP within resource constraints. PrEP providers need to address participants’ need for both convenience and social support.

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Section: Discussionsupporting

confidence: 93%

Section: Methodssupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

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Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

et al. 2021

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“…We observed high drop-offs in PrEP adherence by Week 52: only 348 (81.5%) participants had DBS samples and PrEP was detected in 31% samples at this visit. However, these results are consistent with other PrEP projects among AGYW that have reported declining PrEP adherence over time [12,[65][66][67]. There are several potential mechanisms to explain our findings on the significant negative relationship between depressive symptoms and PrEP use.…”

Section: Group-based Trajectory Modelsupporting

confidence: 92%

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

et al. 2021

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Introduction African adolescent girls and young women (AGYW) eligible for HIV pre‐exposure prophylaxis (PrEP) experience high levels of depressive symptoms. Depression can reduce PrEP adherence among adults, although analyses have considered depression as a time‐varying exposure rather than modelling distinct patterns of symptoms. The association between depressive symptoms and PrEP adherence has not been explored for AGYW. To address these gaps, we sought to understand depressive symptom trajectories among African AGYW initiating PrEP and the impact of time‐varying depressive symptoms and symptom trajectories on PrEP adherence. Methods HPTN 082 was an open‐label PrEP study among AGYW (ages 16 to 24) in Zimbabwe and South Africa from 2016 to 2018. Depressive symptoms were measured at enrolment and Weeks 13, 26 and 52, using the 10‐item Center for Epidemiologic Studies scale; a score ≥10 is indicative of elevated depressive symptoms. PrEP adherence was defined as any detectable tenofovir diphosphate (TFV‐DP) levels. Group‐based trajectory modelling was used to model longitudinal patterns of depressive symptoms. We assessed psychosocial and behavioural predictors of depressive symptom trajectory membership (e.g. PrEP stigma, intimate partner violence [IPV], sexual behaviour). We modelled associations between (1) group trajectory membership and PrEP adherence at Week 52 and (2) time‐varying depressive symptoms and PrEP adherence through follow‐up. Results At enrolment, 179 (41.9%) participants had elevated depressive symptoms. Group‐based trajectory models revealed persistent elevated depressive symptoms in 48.5%, declining symptoms in 9.4% and no consistent or mild depressive symptoms in 43.3%. AGYW who engaged in transactional sex, reported IPV, or had traumatic stress symptoms were more likely to be assigned to the persistent elevated symptom group compared with the consistent no/mild symptom group (Wald test p‐value all <0.01). Participants assigned to the persistent elevated depressive symptom trajectory had a significantly lower risk of detectable TFV‐DP at Week 52 than those in the no/mild symptom trajectory (adjusted prevalence ratio = 0.89; 95% CI: 0.80 to 0.98). Elevated depressive symptoms were significantly inversely associated with PrEP use throughout follow‐up (adjusted relative risk = 0.73; 95% CI = 0.53 to 0.99). Conclusions Persistent depressive symptoms were common among African AGYW seeking PrEP. Integration of depressive symptom screening and treatment into PrEP programmes may improve PrEP effectiveness among African women.

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“…Supportive and non-judgmental counseling was needed as a credible source for PrEP information at uptake and assisted AGYW during the early use phase to think through disclosure and dealing with potential early side-effects. Unfortunately, young women who experienced a lack of (perceived or actual) social support or PrEP-related stigma, avoided disclosure and subsequently struggled with persistence [ 18 , 34 ]. Similarly, AGYW whose sexual relationships were threatened by their PrEP use had more challenges with persistence, as reported in other research with female initiated methods [ 20 , 35 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Successful scale-up of PrEP for HIV prevention in African adolescent girls and young women (AGYW) requires integration of PrEP into young women’s everyday lives. We conducted interviews and focus group discussions with 137 AGYW PrEP users aged 16–25 from South Africa and Kenya. Individual and relational enablers and disablers were explored at key moments during their PrEP-user journey from awareness, initiation and early use through persistence, including PrEP pauses, restarts, and discontinuation. PrEP uptake was facilitated when offered as part of an integrated sexual reproductive health service, but hampered by low awareness, stigma and misconceptions about PrEP in the community. Daily pill-taking was challenging for AGYW due to individual, relational and structural factors and PrEP interruptions (intended or unintended) were described as part of AGYW’s PrEP-user journey. Disclosure, social support, adolescent-friendly health counseling, and convenient access to PrEP were reported as key enablers for PrEP persistence.

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Trajectories of PrEP Adherence Among Young Women Aged 16 to 25 in Cape Town, South Africa

Cited by 21 publications

References 21 publications

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

Assessing longitudinal patterns of depressive symptoms and the influence of symptom trajectories on HIV pre‐exposure prophylaxis adherence among adolescent girls in the HPTN 082 randomized controlled trial

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

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