Background: Integrating PrEP within family planning (FP) clinics could serve as a platform for reaching young women at-risk for HIV in high burden settings. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program is conducting real-world delivery of PrEP to at-risk women seeking routine FP services in Western Kenya.
Methods: PrIYA is part of the DREAMS Innovation Challenge funded by PEPFAR managed by JSI Research & Training Institute, Inc. We approached HIV-uninfected women seeking routine FP services at 16 clinics in Kisumu County, Kenya from June to December 2017. At each encounter, women were screened for behavioral risk factors and willingness to consider PrEP following the national PrEP guidelines. Eligible women who were interested in PrEP were offered PrEP at the same visit.
Results: Overall, we conducted 493 assessments among FP clients for behavioral risk factors and willingness to consider PrEP. Among all women, median age was 25 years (IQR 21-29); 78% were married and 39% did not know their male partner''s HIV status. The most frequently used FP methods were injectables (53%), implants (32%) and oral contraception (7%); 4% used intrauterine devices (IUDs), 4% used condoms alone and 3% used other methods. Overall, 110 (22%) of encounters led to PrEP initiation. Frequency of PrEP initiation differed by male partner HIV status (HIV-negative 11%, unknown 30%, HIV-positive 82%, p< 0.001). Younger women were as likely to initiate PrEP as older women (< 24 vs ≥24 years, OR=1.53, 95% CI 0.93-2.51, p=0.09). Initiating PrEP was associated with having an STI (OR=5.33, 95% CI 1.28-22.09, p=0.021) and experiencing intimate partner violence in the last 6 months (OR=3.17, 95% CI 1.27-7.88, p=0.01). Likelihood of PrEP initiation did not differ between women using a non-barrier FP method (hormonal contraception or IUDs) and women using condoms alone (OR=2.02, 95% CI 0.43-9.48, p=0.37). Frequently reported reasons for declining PrEP included the perception that HIV risk was low (30%) and the partner was HIV-negative (30%).
Conclusions: Among FP clinic attendees in Kenya, PrEP initiators were more likely to have HIV risk factors and just as likely to use FP methods other than condoms as those who declined PrEP.