Uptake of Contraception Among Adolescent Girls and Young Women PrEP Clients: Leveraging the Opportunity to Strengthen HIV and Sexual and Reproductive Health Integration

Abstract

The introduction of oral pre-exposure prophylaxis (PrEP) for HIV prevention was a major breakthrough in South Africa (SA). While the initial introduction focused on issues such as the development and implementation of new guidelines, supply, and the development of demand creation strategies, the need to integrate PrEP services with sexual and reproductive health (SRH) services has gained traction both globally and locally. Project PrEP was implemented in eight healthcare facilities and four mobile clinics in three provinces in SA. Using monitoring data from across the four project clusters, and 4,949 clients, over a 21-month period, we conducted an analysis of baseline routine monitoring data to examine contraceptive uptake in adolescent girls and young women (AGYW) initiating PrEP at project sites. Two-thirds of women (62.3%, n = 3,083) reported the current use of contraception at baseline, with the most commonly used methods being hormonal injectables (61.9%, n = 1,829) and male condoms (19.4%, n = 575). A third (32.3%, n = 603) of the non-contraceptive users accepted a method at PrEP initiation. From a total of 1,007 (32.7%) current contraceptive users at baseline, 865 (85.9%) chose the same or a different method at this visit. The method uptake at PrEP initiation increased the overall contraceptive prevalence by 12.2 to 74.5%. Data indicated that over a third (38.8%, n = 725) who were not using a method at baseline described themselves as consistent condom users. Although a major focus of the project was on PrEP service provision, all women were counseled and offered contraceptive services. The acceptance of a method by a third of non-users was promising; however, more understanding of those who did not take up a method is required. The need to leverage opportunities for the promotion of the integration of HIV and family planning at all levels of PrEP provision was highlighted.

Preferences, educational messaging, and demand creation channels for multipurpose-prevention technologies (MPTs) among women in South Africa

“…In the 2016 South Africa Demographic Health Survey, the unmet need for contraception among adolescent girls (15–19 years) was 8.0%, and young women (20–24 years) (16.0%) [ 14 ]. A Unitaid-funded PrEP Project working across 12 South African sites, found that almost a third (27.7%) of AGYW in their study were not using contraception at their first visit when they initiated on oral pre-exposure prophylaxis (PrEP) for the prevention of HIV [ 16 ]. In 2019, there were also high rates of unintended pregnancies nationally, estimated to be at 76.3% among AGYW (15–19 years), 56.5% among young women (20–24 years), 44.1% among women 25–34 years and 45.2% among older women (35–49 years) [ 17 ].…”

Key programmatic and policy considerations for introducing multipurpose prevention (MPT) methods: reflections from healthcare providers and key stakeholders in South Africa

“…In addition to HIV, there is also a substantial burden of unintended pregnancy and sexually transmitted infections (STIs) in this population group. A Unitaid-funded PrEP Project working across four South African sites since 2018, led by Wits RHI, found that a third of AGYW were not using contraception at their first visit, when they were initiated on oral PrEP ( 4 ). In the same study, among a sub-set of PrEP clients tested for STIs, approximately a third had a curable STI ( 5 ).…”

“…PrEP programmes have shown an unmet need among AGYW, not only for HIV prevention but also for contraception ( 4 , 12 ) and sexually transmitted infection (STI) diagnosis and management ( 13 ). In 2014, the subdermal contraceptive implant was introduced in South Africa, expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector ( 14 ).…”

Young people’s access to sexual and reproductive health prevention services in South Africa during the COVID-19 pandemic: an online questionnaire

“… 16 17 Young women rely on contraception services to prevent unplanned pregnancy and antenatal care if they become pregnant. 18 The estimated pregnancy rate among women aged 15–24 years in South Africa is around 16%–22%. 19 Despite their need and desire to seek SRH services, many young people avoid healthcare services because of real and perceived barriers to care including stigma, cost and healthcare worker judgement, and loss of privacy.…”

“…Young people also depend on SRH services for diagnosis of STI and bacterial vaginosis, which are highly prevalent in South Africa and associated with HIV and poor reproductive and sexual health 16 17. Young women rely on contraception services to prevent unplanned pregnancy and antenatal care if they become pregnant 18. The estimated pregnancy rate among women aged 15–24 years in South Africa is around 16%–22% 19.…”