Structural Influences on Delivery and Use of Oral HIV PrEP Among Adolescent Girls and Young Women Seeking Post Abortion Care in Kenya

Overview

Journal EClinicalMedicine

Specialty General Medicine

Date 2024 Jan 31

PMID 38292038

Authors

Yasaman Zia

Lydia Etyang

Bernard Nyerere

Cyprian Nyamwaro

Felix Mogaka

Margaret Mwangi

Lavender June

Roy Njiru

Job Mokoyo

Susan Kimani

Katherine K Thomas

Kenneth Ngure

Inviolata Wanyama

Elizabeth Bukusi

Nelly Mugo

Renee Heffron

Affiliations

Soon will be listed here.

Abstract

Background: Adolescent girls and young women (AGYW) in East and southern Africa experience a disproportionate burden of HIV incidence. Integrating HIV pre-exposure prophylaxis (PrEP) within existing programs is a key component of addressing this disparity.

Methods: We evaluated an oral PrEP program integrated into post-abortion care (PAC) in Kenya from March 2021 to November 2022. Technical advisors trained staff at PAC clinics on PrEP delivery, abstracted program data from each clinic, and collected data on structural characteristics. Utilizing a modified Poisson regression, we estimated the effect of structural factors on the probability of PrEP offer and uptake.

Findings: We abstracted data on 6877 AGYW, aged 15-30 years, across 14 PAC clinics. PrEP offers were made to 57.4% of PAC clients and 14.1% initiated PrEP. Offers were associated with an increased probability at clinics that had consistent supply of PrEP (relative risk (RR):1.81, 95% CI: 1.1-2.95), inconsistent HIV testing commodities (RR: 1.89, 95% CI: 1.29-2.78), had all providers trained (RR: 1.65, 95% CI: 1.01, 2.68), and were public (RR: 1.89, 95% CI: 1.29-2.78). These same factors were associated with PrEP uptake: consistent supply of PrEP (RR: 2.71, 95% CI: 1.44-5.09), inconsistent HIV testing commodities (RR: 2.55, 95% CI: 1.39-4.67), all providers trained (RR: 2.61, 95% CI: 1.38-4.92), and were public (RR: 2.55, 95% CI: 1.39-4.67).

Interpretation: Greater success with integration of HIV prevention into reproductive health services will likely require investments in systems, such as human resources and PrEP and HIV testing commodities, to create stable availability and ensure consistent access.

Funding: PrEDIRA 2 was supported by funding from Children's Investment Fund Foundation (R-2001-04433). Ms. Zia was funded by the NIH Ruth L. Kirchstein pre-doctoral award (5F31HD105494-02) and Dr. Heffron was funded by National Institute of Mental Health (K24MH123371).

Citing Articles

PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice.

McGuire C, Atieno M, Hoke T, Jeckonia P, Korimba K, Lorenzetti L Curr HIV/AIDS Rep. 2024; 21(5):282-292.

PMID: 39046639 PMC: 11377463. DOI: 10.1007/s11904-024-00704-1.

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