Background: Achieving an AIDS-free generation critically depends on identifying populations at highest HIV risk and scaling up HIV testing, knowledge of HIV status, and HIV prevention uptake, including PrEP. An understanding about adolescent girls and young women (AGYW) acceptance or declining PrEP uptake is needed, which we evaluated in a PrEP delivery project through an adolescent mobile clinic.
Methods: A demonstration project (POWER) was implemented to determine whether AGYW at risk for HIV are motivated to start PrEP and what the preferable mode of distribution could be. Prevention including PrEP was offered to all sexually active AGYW ages 16-25 accessing sexual reproductive health services (SRHS) from an accessible, friendly, adolescent-tailored mobile clinic servicing limited-resource high disease-burden communities of Cape Town, South Africa. All AGYW completed a standardized sexual behaviour HIV risk assessment and risk reduction counselling. A causal-comparative approach, using chi-squared and t-tests, explored the potential effect of HIV risk factors comparing AGYW accepting to those who declined PrEP.
Results: Between June-December 2017, 347 AGYW accessed SRHS in which PrEP was offered and 25% (n=87) initiated PrEP on the same day. Overall, there was no significant difference in total HIV risk factors reported by acceptors (median=3 risk factors) and decliners (median=3) of PrEP. No significant difference in correlates of PrEP accepters and decliners were observed in age of sexual debut, whether her primary partner has other partners, knowing her partner''s HIV status, or being involved in intergenerational or transactional sex. Factors significantly associated with PrEP uptake were visiting the mobile clinic previously (p< 0.001); frequent HIV testing (every 3 months; p< 0.001); inconsistent condom use (p< 0.023); and reporting multiple partners themselves (p< 0.011).
Conclusions: No significant difference existed in risk factors in AGYW accepting or declining PrEP uptake from the mobile. PrEP uptake in this cohort was associated with AGYW''s ''personal agency'' in sexual and health-seeking behaviour more than the risks associated with their current partners. The incongruity between HIV risk awareness and how that translates to behaviour (PrEP uptake) indicates that demand creation should include messaging to build AGYW''s confidence to take ownership of their health and thus apply self-using prevention options.