期刊
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
卷 86, 期 4, 页码 E83-E89出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000002587
关键词
pre-exposure prophylaxis; PrEP; HIV prevention; women; adolescents; Africa
资金
- United States Department of State as part of PEPFAR's DREAMS Partnership
- US National Institutes of Health [R01HD094630, R01HD100201, R01AI125498]
- United States Department of State as part of the DREAMS Innovation Challenge [37188-1088 MOD01]
- University of Washington's Center for AIDS Research Behavioral Sciences Core (CFAR BSC) [P30 AI027757]
- Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh)
The study found that support and encouragement, concealment of pill-taking to avoid negative reactions, and frequent HIV testing were important factors that motivated AGYW to persist with PrEP use. However, the challenge of daily pill-taking remained. During pregnancy, pill-taking was normalized, but concealment became more difficult postpartum.
Background: Discontinuation of daily oral pre-exposure prophylaxis (PrEP) is frequent among adolescent girls and young women (AGYW) in African settings. We explored factors influencing early PrEP discontinuation and persistence among Kenyan AGYW who accepted PrEP within a programmatic setting. Methods: We conducted in-depth interviews with AGYW (aged 15-24 years) who accepted PrEP from 4 maternal child health (MCH) and family planning (FP) clinics. AGYW were identified by nurses at routine clinic visits and purposively sampled based on 4 categories: (1) accepted PrEP pills, but never initiated PrEP use (eg, never swallowed PrEP pills), (2) discontinued PrEP <1 month after initiation, (3) discontinued PrEP within 1-3 months, and (4) persisted with PrEP use >3 months. Informed by the Stages of Change Model, thematic analysis characterized key influences on PrEP discontinuation/persistence. Results: We conducted 93 in-depth interviews with AGYW who accepted pills. Median age was 22 years, 71% were married; 89% were from MCH, and 11% were from FP clinics. Early PrEP use was positively influenced by encouragement from close confidants and effective concealment of PrEP pill-taking when necessary to avoid stigma or negative reactions from partners. Pregnancy helped conceal PrEP use because pill-taking is normalized during pregnancy, but concealment became more difficult postpartum. AGYW found keeping up with daily PrEP pill-taking challenging, and many noted only episodic periods of the HIV risk. Frequently testing HIV-negative reassured AGYW that PrEP was working and motivated persistence. Discussion: As PrEP programs scale-up in MCH/FP, it is increasingly important to enhance protection-effective PrEP use through approaches tailored to AGYW, with special considerations during pregnancy and postpartum.
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