Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa are an important population who could benefit from PrEP. We assessed PrEP uptake and sexual behavior in the Prevention Option for Women Evaluation Research (POWER) cohort.
Methods: POWER is an open label PrEP implementation project investigating PrEP delivery for AGYW aged 16-25 years. PrEP is integrated with reproductive health services at family planning clinics (Kisumu, Kenya), an adolescent and youth-friendly clinic (Johannesburg, South Africa [SA]) and a mobile van for reproductive health services for youth (Cape Town, SA). AGYW are offered PrEP according to national guidelines at quarterly visits over three years. Using baseline demographic and behavioral data, a standardized risk score derived from the VOICE clinical trial was calculated. This VOICE risk score (VRS) was modified to exclude bacterial STIs and HSV2 seropositivity, which are not available at screening, and has a maximum score of 8; VRS ≥4 correlated to an annual HIV incidence >3% and VRS ≥5 correlated to >9% annual HIV incidence in VOICE.
Results: From June through December 2017, 330 AGYW enrolled in POWER (Kisumu n=137, Johannesburg n=107, Cape Town n=86). The median age is 20.5 years (interquartile range [IQR]=19-22) and marital status varied by geographic region (30% married in Kenya vs. 0% in SA). Most participants (82%) were single but had a steady sexual partner, and 17% reported >1 partner in the past three months. Two-thirds (68%) did not know their partners'' HIV status and only 4% were in a known serodiscordant relationship. Self-reported consistent condom use was low (18%) and half (54%) reported contraceptive use. HIV risk, as measured by the VRS, was high: 72% had a VRS ≥5 and 93% had a VRS ≥4. PrEP uptake at the initial visit was 90% across all sites. The main reasons for declining PrEP were fears of HIV stigma or partner reactions.
Conclusions: AGYW in Kenya and South Africa had evidence of high HIV risk using a previously validated risk score, indicating that women initiating PrEP would benefit from it. Notably, they also had high willingness to initiate PrEP when delivered in these youth-friendly settings.