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LOW UPTAKE OF PREEXPOSURE PROPHYLAXIS AMONG KENYAN ADOLESCENT GIRLS AT RISK OF HIV
Lynda M. Oluoch1, Nelly R. Mugo1, Alison C. Roxby2, Anna Wald2, Stacy Selke2, Amalia Magaret2, Kenneth Ngure1, Murugi Micheni1, Steven Gakuo1, Bhavna Chohan2, Catherine Kiptinness1
1Kenya Medical Research Institute, Nairobi, Kenya,2University of Washington, Seattle, WA, USA
A fifth (21%) of new adult HIV infection in Kenya occur among adolescent girls and young women (AGYW) aged 15-24years. Asymptomatic screening of young women for sexually transmitted infections (STIs) is not the standard of care in Kenya. It has been proven that infection with most STIs make it easy to acquire HIV and even easier to transmit it. We examined whether availability of STI screening results would impact HIV Pre exposure prophylaxis (PrEP) acceptability and uptake in this population.
We recruited a prospective cohort of adolescent girls aged 16-20 years in Kenya. To be eligible, the girls were either sexually naïve or had reported one lifetime sexual partner. The girls were followed up every 3 months with regular STI testing, consisting of nucleic acid testing(NAAT) of vaginal swabs for Neisseria gonorrhea, Chlamydia trachomatis, and Trichomonas vaginalis, and vaginal gram stains for bacterial vaginosis (BV). ELISA assay for HIV and HSV-2 was also done. Starting in January 2018, girls were screened with an HIV risk assessment tool, including real-time STI testing and offered PrEP based on their score. We used descriptive analysis to characterize this cohort.
We enrolled 400 girls, with a median age of 18.6 years (IQR 16-21); the cohort started prior to PrEP rollout in Kenya that was initiated in May 2017. After PrEP rollout, we identified 168 girls (42%) eligible for PrEP: 26 (15%) had a current STI, 133 (79%) reported inconsistent or no condom use with sex, 56 (33%) reported sex partner of unknown HIV status, and 6 reported (4%) other reasons. Median years of education for the eligible girls was 12 years. Ninety seven (57.3%) of these girls reported living in rural settlements. Only 9 (5.4%) of the girls who were offered PrEP, accepted it. The PrEP acceptance rate appeared higher in those with current STI (15%, or 4 of 26 accepted PrEP) than in those eligible for other reasons (4%, or 5 of 142 accepted PrEP). Girls who declined PrEP reported that they preferred condom use as a mode of HIV prevention.
In a cohort of young women with access to targeted PrEP services after testing positive for an STI, PrEP acceptance was low. Specific evidence of their own high HIV risk, coupled with low- barrier access to PrEP, did not translate into PrEP uptake among these girls. Specific and targeted research of PrEP uptake reluctance in young women is needed. HIV risk awareness and knowledge is not enough to result in high PrEP uptake in this cohort.