TY - JOUR
T1 - High study participation but diverging adherence levels
T2 - qualitatively unpacking PrEP use among adolescent girls and young women over two years in Eastern Cape, South Africa
AU - Krogstad Mudzingwa, Emily
AU - de Vos, Lindsey
AU - Atujuna, Millicent
AU - Fynn, Lauren
AU - Mugore, Matinatsa
AU - Mabandla, Selly
AU - Hosek, Sybil
AU - Celum, Connie
AU - Bekker, Linda Gail
AU - Daniels, Joseph
AU - Medina-Marino, Andrew
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/4
Y1 - 2024/4
N2 - In Southern and Eastern Africa, initiation of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been high among adolescent girls and young women (AGYW) offered PrEP. However, persistence and prevention-effective use of PrEP among this critical group continues to be a challenge. We conducted a qualitative sub-study of AGYW from the Community PrEP Study in Eastern Cape Province, South Africa who had high rates of pick up for monthly PrEP refills over two years, but differing levels of PrEP adherence based on tenofovir-diphosphate (TFV-DP) measurements in dried blood spots (DBS). Contrasting 22 AGYW with low versus high levels of TFV-DP in DBS, we qualitatively explored factors which influenced PrEP persistence vs. non-persistence, unique patterns of PrEP use (e.g., discarding or stockpiling), and participant recommendations for improving AGYW prevention-effective use of PrEP in the future. Results showed that PrEP misconceptions and mistrust among participants’ social networks negatively influenced adherence. In comparison, supportive families and/or partners and personal trust that PrEP works positively influenced adherence. Those with low adherence described being motivated to come to the site for other study benefits (e.g., reimbursement money, snacks, sanitary pads) and discarding PrEP to avoid stigma associated with being seen with pills. Future PrEP implementation strategies should focus on involving families and partners in PrEP support for AGYW and minimizing PrEP stigma at a community level. Trial registration NCT03977181. Retrospectively registered on June 6, 2019.
AB - In Southern and Eastern Africa, initiation of daily oral pre-exposure prophylaxis (PrEP) for HIV prevention has been high among adolescent girls and young women (AGYW) offered PrEP. However, persistence and prevention-effective use of PrEP among this critical group continues to be a challenge. We conducted a qualitative sub-study of AGYW from the Community PrEP Study in Eastern Cape Province, South Africa who had high rates of pick up for monthly PrEP refills over two years, but differing levels of PrEP adherence based on tenofovir-diphosphate (TFV-DP) measurements in dried blood spots (DBS). Contrasting 22 AGYW with low versus high levels of TFV-DP in DBS, we qualitatively explored factors which influenced PrEP persistence vs. non-persistence, unique patterns of PrEP use (e.g., discarding or stockpiling), and participant recommendations for improving AGYW prevention-effective use of PrEP in the future. Results showed that PrEP misconceptions and mistrust among participants’ social networks negatively influenced adherence. In comparison, supportive families and/or partners and personal trust that PrEP works positively influenced adherence. Those with low adherence described being motivated to come to the site for other study benefits (e.g., reimbursement money, snacks, sanitary pads) and discarding PrEP to avoid stigma associated with being seen with pills. Future PrEP implementation strategies should focus on involving families and partners in PrEP support for AGYW and minimizing PrEP stigma at a community level. Trial registration NCT03977181. Retrospectively registered on June 6, 2019.
KW - Adherence
KW - Adolescent girls and young women
KW - HIV prevention
KW - Pre-exposure prophylaxis
KW - South Africa
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U2 - 10.1007/s10865-023-00462-2
DO - 10.1007/s10865-023-00462-2
M3 - Article
AN - SCOPUS:85179332575
SN - 0160-7715
VL - 47
SP - 320
EP - 333
JO - Journal of Behavioral Medicine
JF - Journal of Behavioral Medicine
IS - 2
ER -