You are here
PERSISTENCE WITH PrEP USE IN AFRICAN ADOLESCENTS AND YOUNG WOMEN INITIATING PrEP
Kenneth K. Mugwanya1, Jillian Pintye1, John Kinuthia2, Harrison Lagat3, Felix Abuna3, Emily R. Begnel1, Julia C. Dettinger1, Grace John-Stewart1, Jared Baeten1
1University of Washington, Seattle, WA, USA,2Kenyatta National Hospital, Nairobi, Kenya,3University of Washington in Kenya, Nairobi, Kenya
Young women in HIV high burden settings are a priority population for PrEP. Limited data are available on PrEP continuation in this population in real world settings.
Data are from the PrEP Implementation for Young Women and Adolescents (PrIYA) project, an implementation program of PrEP integrated in maternal child health (MCH) and family planning (FP) clinics. Between November 2017 and June 2018, women 15-45 years seeking antenatal (ANC), postnatal (PNC) and FP services in 16 health facilities in Kisumu, Kenya were universally screened and offered PrEP according to national guidelines. We assessed for PrEP use and continuation and used robust Poisson regression methods to identify correlates of continuation at 3 and 6 months adjusted for age, marital status, partner HIV status, PrEP delivery point, and facility clustering. Medication possession ratio, assumed to represent PrEP use, was computed as the ratio of the number of tablets dispensed divided by the number of days between initiation and return date, with ratios >1 imputed to 1.
Of 2304 women initiated on PrEP [912 in ANC, 1114 in PNC, and 278 in FP], median age was 24 years (IQR 21-29), 58% had partner of unknown HIV status, and 96% reported recent history of condomless sex. Continuation at 1, 3, and 6 months was 38%, 21%, and 10% overall: 34%, 18%, and 8% for ANC; 39%, 24%, and 10% for PNC; and 41%, 25%, and 15% for FP. Of those continuing PrEP at Month 1 (n=866), median medication possession ratio was 1 (IQR: 0.86-1). Overall, continuation at 3 months was independently higher for women with HIV positive partners (positive 52%, unknown 19%, negative 18%; p<0.01) and in older women (<20 years 23%, 20-24 years 18%, 25-34 years 22%, and ≥35 years 37%; p=0.02). Only partner HIV status was independently associated with 6 month continuation (positive 30%, unknown 8%, negative 8%; p<0.01). Frequently reported reasons for discontinuing PrEP use were low perceived risk for HIV (23%), side effects (19%), pill burden (17%), and partner known to be HIV negative (17%).
Integration of universal screening and counseling for PrEP in routine MCH and FP clinics in Kenya was feasible. There was high drop-off in PrEP continuation, but subset of women persisted with PrEP use through at least 6 months. Greater efforts to support PrEP normalization and persistence for African women are needed.