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The Effect of PrEP Use Disclosure on Adherence in a Cohort of Adolescent Girls and Young Women in South Africa

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Abstract

Effective strategies to support PrEP adherence among adolescent girls and young women (AGYW) are needed. We examined PrEP use disclosure and its effect on adherence among 200 AGYW ages 16–25 initiating PrEP in South Africa to help inform these  strategies. We estimated the relative prevalence of high adherence (intracellular tenofovir-diphosphate concentration ≥ 700 fmol/punch) 3- and 6-months after PrEP initiation among those who disclosed vs. did not disclose their PrEP use, both overall and by age. Most AGYW disclosed to a parent (58%), partner (58%), or friend (81%) by month 6. We did not observe a strong effect of disclosure on adherence overall; however, among younger AGYW (≤ 18 years), those who disclosed to a parent were 6.8 times as likely to have high adherence at month 6 than those who did not (95% CI 1.02, 45.56). More work is needed to understand parents’ roles as allies and identify ways peers and partners can motivate PrEP use for AGYW.

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Data Availability

Data may contain identifying or sensitive patient information. To preserve participant confidentiality, these data cannot be shared publicly. The Principal Investigators of this study, Connie Celum (ccelum@uw.edu) and Linda-Gail Bekker (linda-gail.bekker@hivresearch.org.za), may be contacted with requests to access these data. Access may be granted to those wishing to use the data for research purposes.

Code Availability

Analysis code may be shared upon request to Danielle Giovenco (danielle.giovenco1@gmail.com).

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Funding

This research was supported by Grants R01MH107251 (PIs: Bekker and Celum) and F31MH119965 (PI: Giovenco) from the National Institutes of Health.

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Danielle Giovenco, Audrey Pettifor, Kimberly A. Powers, Brian W. Pence & Jessie K. Edwards

  2. The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa

    Danielle Giovenco, Katherine Gill & Linda-Gail Bekker

  3. Department of Health Behavior and Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lisa Hightow-Weidman

  4. Department of Global Health, University of Washington, Seattle, WA, USA

    Jennifer F. Morton & Connie Celum

  5. RTI International, Women’s Global Health Imperative, Berkeley, CA, USA

    Ariane van der Straten

  6. Department of Medicine, Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, CA, USA

    Ariane van der Straten

  7. Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA

    Connie Celum

Authors
  1. Danielle Giovenco
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  2. Audrey Pettifor
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  3. Kimberly A. Powers
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  4. Lisa Hightow-Weidman
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  5. Brian W. Pence
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  6. Jessie K. Edwards
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  7. Katherine Gill
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  8. Jennifer F. Morton
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  9. Ariane van der Straten
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  10. Connie Celum
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  11. Linda-Gail Bekker
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Contributions

Conceptualization, investigation, and funding acquisition for the trial should be attributed to CC, L-GB, and AVDS. Material preparation and data collection were performed by KG, JM, CC, L-GB, and AVDS. All authors contributed to the conception and design for this post-hoc secondary analysis. The analysis was performed by DG, KP, JE, and BP. The first draft of the manuscript was written by DG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Danielle Giovenco.

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Conflict of interest

The authors have declared that no competing interests exist.

Ethical Approval

All study procedures were approved by the University of Cape Town’s Human Research Ethics Committee and this analysis was approved by the University of North Carolina at Chapel Hill’s Institutional Review Board. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to Participate

All participants provided written informed consent in English or isiXhosa. A parental consent waiver was granted for participants aged 16–17 years.

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Giovenco, D., Pettifor, A., Powers, K.A. et al. The Effect of PrEP Use Disclosure on Adherence in a Cohort of Adolescent Girls and Young Women in South Africa. AIDS Behav 26, 1007–1016 (2022). https://doi.org/10.1007/s10461-021-03455-x

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