Background
Adapting PrEP service delivery to a multi-method market requires real world data on uptake and use patterns. We evaluated method uptake and associated factors, switching and continuation among women offered oral PrEP, the dapivirine ring (PrEP ring), or injectable cabotegravir (CAB PrEP) in the CATALYST study.
Methods
The CATALYST implementation study offered women a choice of three PrEP methods in sites across Lesotho, South Africa, Uganda, and Zimbabwe. We describe PrEP uptake among participants offered choice of all 3 methods enrolled between April and September 2024. Logistic regression assessed factors associated with CAB PrEP uptake. Month-1 PrEP continuation was defined as refill/re-injection within 60 days of starting/restarting a method.
Results
Of 1574 participants enrolled, 1,326 were eligible for all three methods. Twenty-two percent were 18-24 years; 33% were sex workers. Among participants offered only oral PrEP or PrEP ring prior to April 2024 (n=808), 62% switched to CAB PrEP; among new enrollees (n=518), 86% chose CAB PrEP. Overall, the majority chose CAB PrEP (71%), followed by oral PrEP (20%), PrEP ring (7%), and 2% choosing no method (Figure 1). Those reporting prior PrEP ring or oral PrEP use had lower odds of choosing CAB PrEP than PrEP naive participants [aOR=0.51, 95% CI: 0.32-0.80, p=0.003; aOR=0.45, 95% CI: 0.31-0.67, p<0.001]. Being a sex worker or ≤24 years were not significantly associated with CAB PrEP uptake. Month-1 continuation was 83% for CAB PrEP (n=467), 42% for oral PrEP (n=24), and 31% for PrEP ring (n=13) among enrolees.
Conclusions
There is high demand for CAB PrEP, both among existing and new PrEP clients. There are also dedicated PrEP ring and oral PrEP users, even in the context of CAB PrEP. CAB PrEP is popular among both AGYW and sex workers, suggesting broad appeal among priority populations. Initial rates for refill/reinjection are promising but longer-term follow-up is needed.