Perceptions of and interest in HIV pre-exposure prophylaxis use among adolescent girls and young women in Lilongwe, Malawi

Maseko, Bertha; Hill, Lauren; Phanga, Twambilile; Bhushan, Nivedita L.; Vansia, Dhrutika; Kamtsendero, Linda; Pettifor, Audrey; Bekker, Linda‐Gail; Hosseinipour, Mina C.; Rosenberg, Nora E.

doi:10.1371/journal.pone.0226062

Cited by 44 publications

(32 citation statements)

References 17 publications

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“…Whereas the current literature on integrated PrEP-FP delivery often refers to “FP clinics” as a uniform delivery setting, our study revealed key points of heterogeneity between two FP clinics that influenced implementation (e.g., organizational mission, clinic flow). Our finding that the youth-friendly clinic was potentially “low-hanging fruit” for this HIV prevention innovation is consistent with other projects and programs in Kenya [ 6 ], South Africa [ 33 , 34 ], and Malawi [ 35 ], which similarly reported that providers at these venues were generally open to delivering PrEP and that AGYW like obtaining services in these settings. The implications of our findings for scale-up are even clearer when placed within the context of a typology of health facilities recently developed by Dunbar et al based on their assessment of 20 facilities in Kenya and Zimbabwe [ 36 ].…”

Section: Discussionsupporting

confidence: 88%

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Roche

Barnabee

Omollo

et al. 2022

BMC Health Serv Res

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Introduction Across sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study of integrated PrEP-FP service implementation at two FP clinics in Kisumu, Kenya. Methods From June 2017 to May 2020, the Prevention Options for Women Evaluation Research (POWER) study enrolled 1000 sexually active, HIV-negative AGYW age 16 to 25. Actions taken to implement PrEP were captured prospectively in 214 monitoring and evaluation documents and 15 interviews with PrEP implementers. We analysed data using conventional and directed content analysis, with the latter informed by the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation. Results POWER deployed a variety of implementation strategies to train and educate stakeholders (e.g., having new providers shadow PrEP providers); develop stakeholder interrelationships (e.g., organizing support teams with protected time to reflect on implementation progress and make refinements); provide technical assistance; and change physical infrastructure and workflow. Although these strategies reportedly influenced contextual factors across four of the five CFIR domains, they primarily interacted with contextual factors relevant to inner setting, especially implementation climate and readiness for implementation. Overall, implementing PrEP proved easier and less labor-intensive at a private, youth-friendly clinic than a public FP clinic, largely because the baseline structural characteristics (e.g., space, workflow) and organizational mission of the former were more conducive to offering AGYW-centered care. Nevertheless, adoption of PrEP delivery among non-study staff at both sites was low, likely due to the widespread perception that PrEP was not within their scope of work. Conclusions Some FP clinics may be “lower-hanging fruit” than others for PrEP implementation. Approaching PrEP implementation as a behavioral intervention for FP providers may help ensure that providers have the requisite capability, opportunity, and motivation to adopt the clinical innovation. In particular, PrEP implementers should assess the need for implementation strategies that support providers’ clinical decision-making, establish worker expectations and accountability, and address workload constraints. Trial registration Clinical Trial Number: NCT03490058.

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Section: Discussionsupporting

confidence: 88%

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Roche

Barnabee

Omollo

et al. 2022

BMC Health Serv Res

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“…PrEP is an important prevention option for AGYW, providing an opportunity for greater autonomy and control over sexual health. 22 Recent PrEP studies and our findings underscore the need for approaches to support PrEP initiation and adherence to PrEP during periods of use, 23 particularly among the many women in our study who reported condom-less sex. Stigma, norms and sexual partners have been shown to influence PrEP use and adherence.…”

Section: Discussionmentioning

confidence: 53%

The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study

et al. 2021

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IntroductionYoung women who sell sex (YWSS) in Zimbabwe remain at high risk of HIV infection. Effective HIV prevention strategies are needed. Through support to access a combination of evidence-based interventions, including oral pre-exposure prophylaxis (PrEP), the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) partnership aimed to reduce new HIV infections among adolescent girls and young women by 40% over 24 months.MethodsNon-randomised ‘plausibility’ evaluation, powered to detect a 40% HIV incidence difference between DREAMS and non-DREAMS sites. Two large cities with DREAMS funding were included, and four smaller non-DREAMS towns for comparison. In all sites, YWSS were enrolled to a cohort through peer-referral. Women were followed up for 24 months. HIV seroconversion was the primary outcome, with secondary outcomes identified through a theory of change. Outcomes were compared between YWSS recruited in DREAMS cities and non-DREAMS towns, adjusting for individual-level confounders and HIV prevalence at enrolment.ResultsFrom April to July 2017, 2431 women were enrolled, 1859 of whom were HIV negative at enrolment; 1019 of these women (54.8%) were followed up from March to May 2019 and included in endline analysis. Access to clinical services increased, but access to socioeconomic interventions promoted by DREAMS was limited. A total of 79 YWSS HIV seroconverted, with HIV incidence among YWSS in DREAMS cities lower (3.1/100 person-years) than in non-DREAMS towns (5.3/100 person-years). In prespecified adjusted analysis, HIV incidence was lower in DREAMS cities but with weak statistical evidence (adjusted rate ratio (RR)=0.68; 95% CI 0.40 to 1.19; p=0.18). Women in DREAMS cities were more likely to report ever and ongoing PrEP use, consistent condom use, fewer sexual partners and less intimate partner violence.ConclusionIt is plausible that DREAMS lowered HIV incidence among YWSS in two Zimbabwean cities, but our evaluation provides weak statistical evidence for impact and suggests any reduction in incidence was lower than the anticipated 40% decline. We identified changes to some important ‘pathways to impact’ variables, including condom use.

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“…Reinforcing ART adherence strategies would positively contribute to the reduction of HIV transmissions. Similarly, pre-exposure prophylaxis is another emerging biomedical strategy that can be promoted in SSA to benefit sexual partners who are HIVnegative (Maseko et al, 2020, Zimba et al, 2019.…”

Section: Discussionmentioning

confidence: 99%

“We just do it … we are dead already”: Exploring the sexual behaviors of youth living with HIV

Zgambo

Arabiat

Ireson

2022

Journal of Adolescence

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IntroductionThis study aims to describe the sexual behaviors of youth living with human immunodeficiency virus (HIV) in Malawi. As a high‐risk population, understanding the contextual factors that shape their sexual behaviors is of particular interest when designing strategies to reduce HIV transmission.MethodsSemi‐structured qualitative interviews were used to collect information about sexual behaviors from 22 youth (12 females and 10 males) living with HIV aged from 15 to 24 years. All participants were recruited from a specialized HIV clinic in Malawi. Thematic analysis was applied to identify current themes.ResultsThe majority of participants were sexually active. Engaging in sexual behaviors was largely related to social processes identified in three main themes: (1) Risk‐taking in pursuit of confidence and maturity; (2) A lack of voice in decision making concerning practising safe sex; (3) Perceived barriers to safe sex practice such as poverty, dropping out of school, and personal perspectives about transmitting HIV to others.ConclusionOur results suggest that prevention strategies targeting youth social and economic vulnerabilities to social influences are needed to enhance their personal and social skills. We suggest nurturing cultural and religious ceremonies and involving elders to equip youth with skills and knowledge for the prevention of HIV transmission.

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Perceptions of and interest in HIV pre-exposure prophylaxis use among adolescent girls and young women in Lilongwe, Malawi

Abstract: Background

Cited by 44 publications

References 17 publications

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

Implementation strategies for integrating pre-exposure prophylaxis for HIV prevention and family planning services for adolescent girls and young women in Kenya: a qualitative study

The impact of the DREAMS partnership on HIV incidence among young women who sell sex in two Zimbabwean cities: results of a non-randomised study

“We just do it … we are dead already”: Exploring the sexual behaviors of youth living with HIV

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