Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa

Abstract

In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably. Furthermore, operationalising these measures in real-world settings is challenged by the difficulties in defining the denominator for measuring uptake and coverage among AGYW, due to the lack of data and experience required to identify the subset of AGYW at substantial risk of HIV infection. This paper proposes an intervention-centric cascade as a framework for developing a common lexicon of metrics for uptake and coverage of oral PrEP among AGYW. In codifying these indicators, approaches to clearly define metrics for uptake and coverage are outlined, and the discussion on ‘low’ uptake is reframed to focus on achieving the highest possible proportion of AGYW using oral PrEP when they need and want it Recommendations are also provided for making increased investments in implementation research to better quantify the sub-group of AGYW in potential need of oral PrEP.and for improving monitoring systems to more efficiently address bottlenecks in the service delivery of oral PrEP to AGYW so that implementation can be taken to scale.

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

“…Our findings also corroborate previous evidence which suggests that offering PrEP in a youth-friendly environment may promote AGYW's interest in initiating PrEP [23,24]. Most of our interviews were conducted among participants who were able to receive other sexual and reproductive health services in a youth-friendly environment in the context of Girl Power, and described features of this environment as appealing for PrEP distribution as well.…”

Uptake and retention on HIV pre‐exposure prophylaxis among key and priority populations in South‐Central Uganda

“…Such tracking could help estimate the number of individuals who may no longer need PrEP or who used other services. This is consistent with the proposed prevention‐effective approach in which individuals may discontinue PrEP when they do not feel at risk owing to adoption of other prevention strategies or changes in their HIV risk [19,20]. In our upcoming qualitative publications, we will provide information on reasons for discontinuation.…”

Global implementation of PrEP for HIV prevention: setting expectations for impact

“…The impact of PrEP should be assessed by the overall reduction in HIV incidence not just among users but in the broader population. We define coverage as the composite of uptake and persistence with sufficient adherence on PrEP within the target population, functioning then as the link to impact ; critically, high uptake without persistence will not lead to impactful coverage. Like prevalence, coverage can be measured at a given point or over a period of time, though this time period should be reported clearly .…”