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Pre-Exposure Prophylaxis (PrEP) Initiation and Retention Among Young Kenyan Women

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Abstract

The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, Safe) Initiative works to reduce HIV infection among adolescent girls and young women (AGYW) through prevention interventions including Pre-Exposure Prophylaxis (PrEP). Pamoja CBO in Kisumu, Kenya implemented DREAMS. We describe PrEP initiation and persistence in 549 AGYW who started PrEP through Pamoja and factors associated with discontinuation. Median persistence time was 308 days (95% CI 245, 382) with 59% of AGYW discontinuing by the end of the study. The most common reasons for stopping PrEP were lack of perceived risk (27.9%) and relocation (18.7%). In the multivariable model, only age < 18 was associated with stopping PrEP. Younger age was associated with shorter time to discontinuation. Implementing PrEP through DREAMS was successful in supporting initiation of PrEP for AGYW. However, low rates of persistence at 1 year emphasizes the need for strategies to support PrEP persistence if HIV elimination is to be achieved.

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Data Availability

The dataset analyzed during the current study are not publicly available to protect the identity of the young women in the program but are available from the corresponding author on reasonable request.

Code Availability

The code is available upon reasonable request.

References

  1. UNAIDS. 2020 Global AIDS Update—Seizing the moment—Tackling entrenched inequalities to end epidemics. 2020.

  2. Avert. HIV and AIDS in East and Southern Africa regional overview. 2017.

  3. WHO. Kenya country cooperation strategy at a glance. Geneva: World Health Organization; 2018.

    Google Scholar 

  4. UNAIDS. Fact sheet—latest global and regional statistics on the status of the AIDS epidemic. Geneva: UNAIDS; 2019.

    Google Scholar 

  5. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.

    Article  CAS  Google Scholar 

  6. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  Google Scholar 

  7. Dunbar MS, Kripke K, Haberer J, Castor D, Dalal S, Mukoma W, et al. Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa. Sex Health. 2018;15(6):513–21.

    Article  Google Scholar 

  8. Haberer JE, Mugo N, Baeten JM, Pyra M, Bukusi E, Bekker L-G. PrEP as a lifestyle and investment for adolescent girls and young women in sub-Saharan Africa. J Int Assoc Provid AIDS Care (JIAPAC). 2019;18:2325958219831011.

    Google Scholar 

  9. Sidebottom D, Ekström AM, Strömdahl S. A systematic review of adherence to oral pre-exposure prophylaxis for HIV—how can we improve uptake and adherence? BMC Infect Dis. 2018;18(1):581.

    Article  Google Scholar 

  10. Camlin CS, Koss CA, Getahun M, Owino L, Itiakorit H, Akatukwasa C, 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.

    Article  Google Scholar 

  11. 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(554):e25298-e.

    Google Scholar 

  12. Hosek S, Pettifor A. HIV prevention interventions for adolescents. Curr HIV/AIDS Rep. 2019;16(1):120–8.

    Article  Google Scholar 

  13. Haberer JE, Baeten JM, Campbell J, Wangisi J, Katabira E, Ronald A, et al. Adherence to antiretroviral prophylaxis for HIV prevention: a substudy cohort within a clinical trial of serodiscordant couples in East Africa. PLoS Med. 2013;10(9):e1001511.

    Article  Google Scholar 

  14. Thomson KA, Baeten JM, Mugo NR, Bekker LG, Celum CL, Heffron R. Tenofovir-based oral preexposure prophylaxis prevents HIV infection among women. Curr Opin HIV AIDS. 2016;11(1):18–26.

    Article  CAS  Google Scholar 

  15. Kenya National Bureau of S, Ministry of HK, National ACCK, Kenya Medical Research I, National Council for P, Development/Kenya. Kenya Demographic and Health Survey 2014. Rockville, MD, USA; 2015.

  16. Council P. Reducing HIV risk among young women and their partners: highlights from the DREAMS implementation science research portfolio. Washington: Population Council; 2020.

    Google Scholar 

  17. Rousseau-Jemwa E, Bekker L-G, Bukusi E, Delaney-Moretlwe S, Omollo V, Travill D, et al. Early persistence of HIV pre-exposure prophylaxis (PrEP) in African adolescent girls and young Women (AGYW) from Kenya and South Africa. AIDS Res Hum Retroviruses. 2018;34:68–68.

    Google Scholar 

  18. Balkus JE, Brown E, Palanee T, Nair G, Gafoor Z, Zhang J, et al. An empiric HIV risk scoring tool to predict HIV-1 acquisition in African women. J Acquir Immune Defic Syndr (1999). 2016;72(3):333–43.

    Article  Google Scholar 

  19. Corneli A, Perry B, Agot K, Ahmed K, Malamatsho F, Van Damme L. Facilitators of adherence to the study pill in the FEM-PrEP clinical trial. PLoS ONE. 2015;10(4):e0125458.

    Article  Google Scholar 

  20. Celum CL, Delany-Moretlwe S, McConnell M, van Rooyen H, Bekker L-G, Kurth A, et al. Rethinking HIV prevention to prepare for oral PrEP implementation for young African women. J Int AIDS Soc. 2015;18(4 Suppl 3):20227.

    Article  Google Scholar 

  21. Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, et al. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav. 2013;17(6):2162–72.

    Article  Google Scholar 

  22. Magazi B, Stadler J, Delany-Moretlwe S, Montgomery E, Mathebula F, Hartmann M, et al. Influences on visit retention in clinical trials: Insights from qualitative research during the VOICE trial in Johannesburg, South Africa. BMC Womens Health. 2014;14(1):88.

    Article  Google Scholar 

  23. WHO. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization; 2013.

    Google Scholar 

  24. USAID. The Power Of Dreams HIV Prevention For AGYW in Western Kenya. 2020.

  25. Karim QA, Humphries H, Stein Z. Empowering women in human immunodeficiency virus prevention. Best Pract Res Clin Obstet Gynaecol. 2012;26(4):487–93.

    Article  Google Scholar 

  26. Pettifor AE, Measham DM, Rees HV, Padian NS. Sexual power and HIV risk, South Africa. Emerg Infect Dis. 2004;10(11):1996–2004.

    Article  Google Scholar 

  27. Birdthistle I, Schaffnit SB, Kwaro D, Shahmanesh M, Ziraba A, Kabiru CW, et al. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health. 2018;18:1–15.

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge and thank the Pamoja staff members and DREAMS beneficiaries who participated in or contributed to our study. We would also like to thank the Ministry of Health, Seme Sub-County and village leaders who helped make this study a possibility.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, USA

    Ramael O. Ohiomoba, Ashley Ezema & Maya Jackson-Gibson

  2. Department of Anthropology, Northwestern University, Evanston, USA

    Patrick Mbullo Owuor

  3. Pamoja CBO, Kisumu, Kenya

    Patrick Mbullo Owuor, Wicklife Orero, Irene Were & Franklin Sawo

  4. Department of Medical Social Science, Feinberg School of Medicine, Northwestern University, Chicago, USA

    Lisa R. Hirschhorn

  5. Institute of Global Health, Northwestern University, Chicago, USA

    Lisa R. Hirschhorn

  6. 175 East Delaware, Apt. 8708, Chicago, IL, 60611, USA

    Ramael O. Ohiomoba

Authors
  1. Ramael O. Ohiomoba
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  2. Patrick Mbullo Owuor
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  3. Wicklife Orero
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  4. Irene Were
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  5. Franklin Sawo
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  6. Ashley Ezema
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  7. Maya Jackson-Gibson
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  8. Lisa R. Hirschhorn
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Contributions

ROO and LRH conceptualized the study and manuscript. ROO conducted the data analysis, interpreted the study results, and was the major contributor in writing the manuscript. LRH and PMO also contributed significantly to the interpretation of the results and writing of the manuscript. FS helped compile and provide access to the data. All authors read, reviewed, and approved the final manuscript.

Corresponding author

Correspondence to Ramael O. Ohiomoba.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study was approved by the Institutional Review Board of Northwestern University (STU00207400) and Ethical and Scientific Review Committee of AMREF (P470-2018) African Medical Research Education Foundation.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

At the time of enrollment, beneficiaries signed a written consent form to participate in a study evaluating the DREAMS program and allowing their information to be shared with study partners. Furthermore, the data used in this project was routine programmatic data and was deidentified.

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Ohiomoba, R.O., Owuor, P.M., Orero, W. et al. Pre-Exposure Prophylaxis (PrEP) Initiation and Retention Among Young Kenyan Women. AIDS Behav 26, 2376–2386 (2022). https://doi.org/10.1007/s10461-022-03576-x

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  • DOI: https://doi.org/10.1007/s10461-022-03576-x

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