Tu'Washindi na PrEP: Working With Young Women and Service Providers to Design an Intervention for PrEP Uptake and Adherence in the Context of Gender-Based Violence

Abstract

HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition among adolescent girls and young women (AGYW). Existing evidence suggests that uptake and adherence are low among AGYW and that relationship factors such as gender-based violence (GBV) are important barriers. Through a community-based participatory research (CBPR) process, a youth advisory board (YAB), service providers (SP), and a study team developed the Tu'Washindi na PrEP intervention to support AGYW PrEP use in the context of GBV. The YAB also guided the formative research and interpretation of results. The authors pretested the intervention with SP, AGYW and their partners, and community change agents, and then developed guides for AGYW support clubs, community-based male sensitization sessions, and couples-based events that included formulation of story lines for dramatized PrEP negotiation and information dissemination skills. Stakeholder engagement led to an intervention responsive to AGYW's needs for PrEP support in the context of their relationships, which was evaluated through a 6-month pilot community randomized controlled trial.

Qualitative Analysis Using Social Maps to Explore Young Women's Experiences With Social Support of their Oral PrEP Use in Kenya and South Africa

“…It is worth noting that some AGYW in this study described their partners as positive influencers. Still, our findings validate the need to continue to research this important group and find the most effective interventions to improve AGYW PrEP adherence, including by fostering the positive supportive relationships and mitigating or altering the negative partner influences (Hartmann et al, 2019, 2021). In addition, long-acting HIV prevention methods, particularly those that can be used discreetly by women (e.g., vaginal rings, implants, and injectables), may help alleviate some of the concerns about partner influence and are an important field of continued research (HIV.gov; Minnis et al, 2020).…”

“…The theme of stigma across social groups, and AGYW's call for more PrEP education for all influencers, highlights the need for a multifaceted PrEP sensitization approach that reaches a wide range of stakeholders. AGYW specifically identified clinic staff as best suited to educate their communities on PrEP, as has been noted elsewhere (Giovenco et al, 2021;Hartmann et al, 2021). One possibility is that this indicates a self-awareness that the young women have low social power in their society and are not regarded as trusted sources of information by their social networks (Hartmann et al, 2021).…”

“…AGYW specifically identified clinic staff as best suited to educate their communities on PrEP, as has been noted elsewhere (Giovenco et al, 2021;Hartmann et al, 2021). One possibility is that this indicates a self-awareness that the young women have low social power in their society and are not regarded as trusted sources of information by their social networks (Hartmann et al, 2021). It could also point to an overall respect for the clinic staff and young women's understanding of the trust that the community has in health care experts.…”

“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

“…Open dialogue and engagement with faith leaders to educate community gatekeepers about new HIV prevention options is critical, particularly in the sub-Saharan African context [ 30 ]. In addition, the engagement of men and boys is a critical factor in creating an enabling environment for PrEP use amongst AGYW, specifically efforts to address male perceptions that associate female PrEP use with promiscuity and mistrust [ 46 ].…”

Partner violence as conversation opener for preexposure prophylaxis use among younger women

“…In this regard, older adolescents may be more aware of strategies to protect themselves from violence or have more agencies to do so. In Kenya, women were motivated to use PrEP in the context of IPV but worried that men's lack of awareness of PrEP could lead to relationship conflict [10]. These findings remind us that many women demonstrate a strategic ability to navigate the complexities of violent relationships [11,12], and appreciate tools (like PrEP) that they can use when safe and desirable.…”