Exploring the Performance and Impact of Oral PrEP in Adolescent Girls and Young Women in Makonde District, Mashonaland West

Abstract

This study presents findings from a cross-sectional analytic study utilising a mixed-method approach to evaluate the performance and impact of Oral Pre-Exposure Prophylaxis (PrEP) among Adolescent Girls and Young Women (AGYW) in Makonde District, Mashonaland West. The objectives of the study were to analyse the initiation, retention, and adherence rates, and explore barriers to PrEP use among AGYW using the HIV prevention cascade. The study involved a review of 245 PrEP user records, in-depth interviews and focus group discussions with 81 current and former PrEP users, and discussions with 29 service providers serving as key informants. User records were selected using multi-stage sampling at public health facilities and, PrEP users and service providers were purposively sampled into the study to provide insights on the performance of oral PrEP in the district. The research revealed a low initiation rate of 47% (CI 41-52.9) among AGYW and a much lower initiation rate of 36.6% among 18-year-old adolescents. Multivariate analysis revealed a statistically significant association between retention on PrEP and the prescribing facility (Hazard ratio 0.3, p< 0.05, 95%CI 0.2-0.5). And age (>23years) among the AGYW was a good predictor of retention of Oral PrEP. There was no statistically significant association between adherence and sociodemographic characteristics (p>0.05).Thirty percent of users discontinued PrEP in the first month post-initiation and they were not followed up to ascertain if the period of risk had elapsed. Alarmingly, about 85% of users discontinued PrEP by the 6th month post-initiation, and 23.1% (-/+3.7sd) of AGYW defaulted before each subsequent visit. According to AGYW in the study, barriers to both initiation and retention of PrEP included negative health worker attitudes (n=17, 21%), fear of side effects (n=25, 30.9%), and inefficient service delivery (n=35, 43.2%). Healthcare providers (27.6%) also cited stigma, both historical and social, as a significant barrier to PrEP delivery. 58% of the study participants prefer integration of PrEP services with routine family clinics e.g. family planning services. More than 75% (n=62) of the former and current PrEP users admitted that they did not change their sexual behaviour after initiating PrEP. And in the period under study only one PrEP user seroconverted. However, the study highlighted a high HIV burden in Makonde district, with new HIV infections among AGYW four times higher than the cases reported in their male counterparts. These findings underscore the urgent need for targeted interventions to address the identified barriers and improve initiation and retention of PrEP among AGYW in the study area to effectively combat the HIV epidemic.