Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya

Tapsoba, Jean de Dieu; Zangeneh, Sahar Z.; Appelmans, Eline; Pasalar, Siavash; Mori, Kira; Peng, Lily; Tao, Janice; Drain, Paul K.; Okomo, Gordon; Bii, Stanley; Mukabi, James; Zobrist, Stephanie; Brady, Martha; Obanda, Rael; Madiang, Daniel Oluoch; Cover, Jane; Duerr, Ann; Chen, Ying Qing; Obong’o, Christopher

doi:10.1080/09540121.2020.1822505

Cited by 37 publications

(34 citation statements)

References 35 publications

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“…Despite progress in the uptake of oral PrEP, studies have shown that many users discontinue oral PrEP within 1 to 3 months, and continuation rates have been low [7][8][9][10]. A systematic meta-analysis that included clinical trials, demonstration projects and real-world settings on oral PrEP continuation found that on average 65% continued oral PrEP at month 1 [7].…”

Section: Introductionmentioning

confidence: 99%

Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

et al. 2022

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HIV incidence among women in Eastern and Southern Africa remains unacceptably high, highlighting the need for effective HIV prevention options, including pre-exposure prophylaxis (PrEP). The Evidence for Contraceptive Options and HIV Outcomes trial offered daily oral PrEP to participants during the latter part of the clinical trial as an additional HIV prevention choice. We explored daily oral PrEP continuation at trial exit among women enrolled from Durban, South Africa who initiated oral PrEP at the trial site. Of the 132 women initiating oral PrEP, 87% reported continuation of oral PrEP at month 1, 80% at month 3, and 75% continued using oral PrEP at their final trial visit and were referred to off-site facilities for ongoing oral PrEP access. The median duration of oral PrEP use in trial participants who used oral PrEP was 91 days (IQR 87 to 142 days). Women who disclosed their oral PrEP use to someone had increased odds of continuing oral PrEP at trial exit. Women who reported > 1 sex partner and those who felt they would probably or definitely get infected with HIV had reduced odds of continuing oral PrEP at trial exit. Of those discontinuing oral PrEP (n = 32), > 50% discontinued within the first month, and the most common reason for discontinuation was reporting side effects. The high rates of oral PrEP continuation in our study are encouraging and our findings can be utilized by other clinical trials providing oral PrEP as standard of care for HIV prevention and by oral PrEP implementation programmes.

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Section: Introductionmentioning

confidence: 99%

Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

et al. 2022

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“…Other populations, such as adolescent girls and young women, may not be resourced or empowered to engage in sexual health. 15 Data from LMICs and among key populations such as sex workers are often not routinely collected, but available studies have demonstrated mental health disparities of an equivalent-if not greater-magnitude compared with those observed in high-income settings. 16 Studies of PrEP users, in particular, document high rates of mental disorders and poor mental health.…”

Section: Mental Disorders Among Prep Users: a Threat To Effective Implementationmentioning

confidence: 99%

Roll-out of HIV pre-exposure prophylaxis: a gateway to mental health promotion

et al. 2021

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HIV remains a pressing global health problem, with 1.5 million new infections reported globally in 2020. HIV pre-exposure prophylaxis (PrEP) can lower the likelihood of HIV acquisition among populations at elevated risk, yet its global roll-out has been discouragingly slow. Psychosocial factors, such as co-occurring mental illness and substance use, are highly prevalent among populations likely to benefit from PrEP, and have been shown to undermine persistence and adherence. In this analysis, we review the high burden of mental health problems among PrEP candidates and contend that inattention to mental health stands to undermine efforts to implement PrEP on a global scale. We conclude that integration of mental health screening and treatment within PrEP scale-up efforts represents an important strategy for maximising PrEP effectiveness while addressing the high burden of mental illness among at-risk populations. As implementers seek to integrate mental health services within PrEP services, efforts to keep access to PrEP as low-threshold as possible should be maintained. Moreover, programmes should seek to implement mental health interventions that are sensitive to local resource constraints and seek to reduce intersecting stigmas associated with HIV and mental illness.

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“…Oral pre-exposure prophylaxis (PrEP) has become a primary focus of HIV prevention efforts because it is safe and highly efficacious [26]. Given their risk, AGYW are a priority population for PrEP, yet research suggests that PrEP access, uptake, adherence, and continuation is low among AGYW [15,[27][28][29][30]. The HIV prevention field experienced a paradigm shift in May 2017, when-after a national pilot program [31]-PrEP became widely available to Kenyans, including AGYW.…”

Section: Introductionmentioning

confidence: 99%

“…Per Dunbar et al, the oral PrEP cascade underscores that there must be synergy between service availability and screening, offer, and initiation processes for the total target population (i.e., "all seronegative [AGYW] at risk for HIV who could benefit from PrEP") to start PrEP [33]. Because PrEP initiation, adherence, and continuation among AGYW is low [15,[27][28][29][30] and affected by low perceived risk and concerns of pill burden, partner disapproval, side effects, and stigma [34][35][36][37][38], researchers, program planners, and implementers have concentrated on the cascade's downstream factors. While warranted, emphasis on these downstream elements has led to a dearth of information on upstream processes, knowledge that would help illuminate if and how vulnerable AGYW are being identified and offered PrEP services.…”

Section: Introductionmentioning

confidence: 99%

Oral PrEP Consultations Among Adolescent Girls and Young Women in Kisumu County, Kenya: Insights from the DREAMS Program

Heck

Mathur

Alwang'a³

et al. 2022

AIDS Behav

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Although Kenya nationally scaled up oral pre-exposure prophylaxis (PrEP) in May 2017, adolescent girls’ (AG, aged 15–19 years) and young women’s (YW, aged 20–24 years) PrEP use remains suboptimal. Thus, we analyzed PrEP consultations—interactions with a healthcare provider about PrEP—among Kenyan AGYW. In April-June 2018, AGYW enrolled in DREAMS in Kisumu County, Kenya self-reported their HIV-related knowledge, behaviors, and service use. Among HIV negative, sexually active AG (n = 154) and YW (n = 289), we examined associations between PrEP eligibility and PrEP consultations using prevalence ratios (PR, adjusted: aPR). Most AG (90.26%) and YW (94.12%) were PrEP-eligible due to inconsistent/no condom use, violence survivorship, or recent sexually transmitted infection symptoms. Between PrEP-eligible AG and YW, more YW were ever-orphaned (58.09%), ever-married (54.41%), ever-pregnant (80.88%), and out of school (78.31%); more PrEP-eligible YW reported PrEP consultations (41.18% vs. 24.46%, aPR = 1.51 [1.01–2.27]). AG who used PEP (post-exposure prophylaxis) reported more consultations (aPR = 5.63 [3.53–8.97]). Among YW, transactional sex engagers reported more consultations (58.62% vs. 39.09%, PR = 1.50 [1.06–2.12]), but only PEP use (aPR = 2.81 [2.30–3.43]) and multiple partnerships (aPR = 1.39 [1.06–1.82]) were independently associated with consultations. Consultations were lowest among those with 1 eligibility criterion (AG = 11.11%/YW = 27.18%). Comparatively, consultations were higher among AG and YW with 2 (aPR = 3.71 [1.64–8.39], PR = 1.60 [1.07–2.38], respectively) or ≥ 3 (aPR = 2.51 [1.09–5.78], PR = 2.05 [1.42–2.97], respectively) eligibility criteria. Though most AGYW were PrEP-eligible, PrEP consultations were rare and differed by age and vulnerability. In high-incidence settings, PrEP consultations should be conducted with all AGYW. PrEP provision guidelines must be re-assessed to accelerate AGYW’s PrEP access.

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Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya

Cited by 37 publications

References 35 publications

Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

Daily Oral Pre-exposure Prophylaxis (PrEP) Continuation Among Women from Durban, South Africa, Who Initiated PrEP as Standard of Care for HIV Prevention in a Clinical Trial

Roll-out of HIV pre-exposure prophylaxis: a gateway to mental health promotion

Oral PrEP Consultations Among Adolescent Girls and Young Women in Kisumu County, Kenya: Insights from the DREAMS Program

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