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Factors influencing adolescent girls and young women’s uptake of community-based PrEP services following home-based HIV testing in Eastern Cape, South Africa: a qualitative study

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Home-based service delivery has been used to improve access to HIV testing and antiretroviral initiation across sub-Saharan Africa, but it has yet to be leveraged to improve pre-exposure prophylaxis (PrEP) uptake. We interviewed 37 adolescent girls and young women (AGYW) in Eastern Cape, South Africa to explore why they chose to initiate PrEP or not following home-based HIV testing and referral for PrEP, and what influenced time to PrEP initiation. Participants reported that home visits provided a source of trusted information and a way to involve family members in their PrEP initiation decisions, motivating some to start PrEP. AGYW who initiated PrEP were more likely to qualitatively perceive themselves to be at high risk for HIV compared with those who never initiated PrEP. Integrating home-based HIV testing with PrEP education and referral may be a valuable way to reduce familial barriers and boost PrEP uptake among AGYW in South Africa.

Trial registration: NCT03977181. Retrospectively registered on June 6, 2019.

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We thank Ms. Keabetswe Kodi, Ms. Lungelwa Mlanjeni, and Mr. Ralph Mawarire of the Foundation for Professional Development for project coordination and support. We thank our field teams for their dedication and hard work. We thank Buffalo City Metro Department of Health (BCM-DoH), and specifically, Mrs. Selly Mabandla, BCM-DoH HIV/AIDS, STIs and TB (HAST) Program Manager, for their support and engagement in ensuring successful implementation of this study. Finally, we kindly thank and greatly appreciate all of the adolescent girls and young women in our study who agreed to be interviewed and shared their experiences with us, thus allowing for this study output.


This research is funded by the National Institute of Mental Health (NIMH) of the U.S. National Institutes of Health under award number R01MH114648 to AMM and LGB. Complementary funding was provided by The Bill and Melinda Gates Foundation though the South African National HIV Think Tank to AMM and JD. The funders had no role in the study design, data collection and analysis, nor will they have any role in manuscript preparations or publication decisions.

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Authors and Affiliations



Conceptualization: Millicent Atujuna, Linda-Gail Bekker, Andrew Medina-Marino; Project administration: Lindsey de Vos, Lauren Fynn, Matinatsa Mugore; Methodology: Millicent Atujuna, Joseph Daniels, Lindsey de Vos, Lauren Fynn, Andrew Medina-Marino, Matinatsa Mugore; Analysis: Millicent Atujuna, Joseph Daniels, Lindsey de Vos, Lauren Fynn, Emily Krogstad Mudzingwa; Data curation: Lindsey de Vos, Emily Krogstad Mudzingwa, Matinatsa Mugore; Visualization: Lauren Fynn, Emily Krogstad Mudzingwa; Writing - original draft preparation: Emily Krogstad Mudzingwa; Writing - review and editing: Millicent Atujuna, Linda-Gail Bekker, Connie Celum, Joseph Daniels, Lindsey de Vos, Lauren Fynn, Sybil Hosek, Emily Krogstad Mudzingwa, Andrew Medina-Marino; Funding acquisition: Linda-Gail Bekker, Joseph Daniels, Andrew Medina-Marino; Resources: Linda-Gail Bekker, Andrew Medina-Marino; Supervision: Linda-Gail Bekker, Connie Celum, Sybil Hosek, Andrew Medina-Marino.

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Correspondence to Andrew Medina-Marino.

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The authors have no competing interests to declare that are relevant to the content of this article.

Ethics approval

The protocol, informed consent documents, and tools were approved by the ethical review committee at the University of Cape Town (HREC 289/2018). Approval to conduct the research in Eastern Cape Province was provided by the Eastern Cape Provincial Department of Health. This study was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Mudzingwa, E.K., de Vos, L., Atujuna, M. et al. Factors influencing adolescent girls and young women’s uptake of community-based PrEP services following home-based HIV testing in Eastern Cape, South Africa: a qualitative study. AIDS Behav 26, 3726–3739 (2022).

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