Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe

doi:10.1007/s10461-024-04503-y

. 2024 Sep 30.

doi: 10.1007/s10461-024-04503-y. Online ahead of print.

Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe

Affiliations

¹ Women's Global Health Imperative, RTI International, Berkeley, CA, USA. mshapley@rti.org.
² Wits Reproductive Health and HIV Institute, Johannesburg, South Africa.
³ Division of Global Emergency Medicine, Brown University, Kigali, Rwanda.
⁴ University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
⁵ Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
⁶ Desmond Tutu HIV Centre, Cape Town, South Africa.
⁷ Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
⁸ , FHI 360, Durham, NC, USA.
⁹ School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
¹⁰ Department of Global Health, University of Washington, Seattle, WA, USA.
¹¹ Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA.
¹² ASTRA Consulting, Kensington, CA, USA.

PMID: 39343865
DOI: 10.1007/s10461-024-04503-y

Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe

Mary Kate Shapley-Quinn et al. AIDS Behav. 2024.

. 2024 Sep 30.

doi: 10.1007/s10461-024-04503-y. Online ahead of print.

Authors

Affiliations

¹ Women's Global Health Imperative, RTI International, Berkeley, CA, USA. mshapley@rti.org.
² Wits Reproductive Health and HIV Institute, Johannesburg, South Africa.
³ Division of Global Emergency Medicine, Brown University, Kigali, Rwanda.
⁴ University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
⁵ Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
⁶ Desmond Tutu HIV Centre, Cape Town, South Africa.
⁷ Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
⁸ , FHI 360, Durham, NC, USA.
⁹ School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
¹⁰ Department of Global Health, University of Washington, Seattle, WA, USA.
¹¹ Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA, USA.
¹² ASTRA Consulting, Kensington, CA, USA.

PMID: 39343865
DOI: 10.1007/s10461-024-04503-y

Abstract

Rates of HIV acquisition remain high among adolescent girls and young women (AGYW) in sub-Saharan Africa. We explored South African, Ugandan, and Zimbabwean AGYW's experiences in a crossover trial of two HIV prevention products: Daily oral pre-exposure prophylaxis pills and a monthly dapivirine vaginal ring. A subset of participants (n = 25) across all sites completed up to three serial in-depth interviews (SIDIs). The SIDIs explored barriers to product use, coping strategies, and the resulting outcomes. Coded textual data were analyzed using a product acceptability conceptual framework. Participants in the SIDIs described managing the array of challenges they encountered through formal adherence support, strategic product disclosure, and personally adapted strategies. For both products, perceived discreetness of the product and decision-making around disclosure was an important component of participants' narratives. Participants tailored their coping strategies based on available personal resources (e.g., cell phone alarms for PrEP reminders, social support through disclosure) or study provided resources (e.g., encouragement from staff, adherence groups). Notably, challenges participants encountered with each product during the crossover period helped inform product selection during the choice period. Our findings suggest that-even in a context where AGYW have access to several options for HIV prevention-challenges to consistent product use remain, but accessible support mechanisms and informed choice can help mitigate these challenges. Enacting that choice may also empower AGYW to reach their short and long-term life goals-including for HIV prevention. (NCT03593655, 20th July 2018).

Keywords: Adherence support; Adolescent girls and young women; HIV prevention; Pre-exposure prophylaxis; Qualitative; Sub-Saharan Africa.

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Cited by

Awareness of Heightened Sexual and Behavioral Vulnerability as a Trigger for PrEP Resumption Among Adolescent Girls and Young Women in East and Southern Africa.
Reddy K, Palanee-Phillips T, Heffron R. Reddy K, et al. Curr HIV/AIDS Rep. 2023 Dec;20(6):333-344. doi: 10.1007/s11904-023-00680-y. Epub 2023 Dec 5. Curr HIV/AIDS Rep. 2023. PMID: 38051383 Free PMC article. Review.

References

1. Joint United Nations Programme on HIV/AIDS. UNAIDS DATA 2022. Geneva2022.
1. Camlin CS, Koss CA, Getahun M, et al. Understanding demand for PrEP and early experiences of PrEP Use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav. 2020;24(7):2149–62. - DOI - PubMed - PMC
1. Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(S4):e25298. - DOI - PubMed - PMC
1. Bekker L-G, Pike C, Hillier SL. HIV prevention: better choice for better coverage. J Int AIDS Soc. 2022;25(1):e25872. - DOI - PubMed - PMC
1. Williams KM, Miller N, Tutegyereize L, et al. Defining principles for a choice-based approach to HIV prevention. The Lancet HIV. 2023;10(4):e269–72. - DOI - PubMed

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[1] Joint United Nations Programme on HIV/AIDS. UNAIDS DATA 2022. Geneva2022.

[2] Joint United Nations Programme on HIV/AIDS. UNAIDS DATA 2022. Geneva2022.

[3] Camlin CS, Koss CA, Getahun M, et al. Understanding demand for PrEP and early experiences of PrEP Use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav. 2020;24(7):2149–62. - DOI - PubMed - PMC

[4] Camlin CS, Koss CA, Getahun M, et al. Understanding demand for PrEP and early experiences of PrEP Use among young adults in rural Kenya and Uganda: a qualitative study. AIDS Behav. 2020;24(7):2149–62. - DOI - PubMed - PMC

[5] Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(S4):e25298. - DOI - PubMed - PMC

[6] Celum CL, Delany-Moretlwe S, Baeten JM, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(S4):e25298. - DOI - PubMed - PMC

[7] Bekker L-G, Pike C, Hillier SL. HIV prevention: better choice for better coverage. J Int AIDS Soc. 2022;25(1):e25872. - DOI - PubMed - PMC

[8] Bekker L-G, Pike C, Hillier SL. HIV prevention: better choice for better coverage. J Int AIDS Soc. 2022;25(1):e25872. - DOI - PubMed - PMC

[9] Williams KM, Miller N, Tutegyereize L, et al. Defining principles for a choice-based approach to HIV prevention. The Lancet HIV. 2023;10(4):e269–72. - DOI - PubMed

[10] Williams KM, Miller N, Tutegyereize L, et al. Defining principles for a choice-based approach to HIV prevention. The Lancet HIV. 2023;10(4):e269–72. - DOI - PubMed

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Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe

Affiliations

Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe

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