Intervention promotes PrEP uptake, adherence in Kenyan adolescent girls and young women
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A three-pronged intervention promoted HIV pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women in Kenya who face significant barriers to care, researchers reported.
The Tu’Washindi intervention was conducted in Siaya County, Kenya, where intimate partner violence and gender inequity — two barriers to PrEP use — are prevalent, said Sarah T. Roberts, PhD, MPH, an investigator in the Women’s Global Health Imperative at RTI International, and colleagues.
According to Roberts and colleagues, adolescent girls and young women in sub-Saharan Africa are “a priority population for epidemic control” of HIV.
“One reason for this is that young women face substantial relationship-related barriers to PrEP use, including intimate partner violence, fear of it, their lack of decision-making power and partner opposition,” Roberts told Healio.
Rolled out over 6 months, the intervention included an eight-session empowerment-based support club, a community sensitization event that was targeted to male partners, and a PrEP education event for couples. Eligible participants were aged between 17 and 24 years, did not have HIV and were either eligible for or already taking PrEP.
The 103 adolescent girls and young women enrolled in the study had a median age of 22 years, 95% had a primary partner, 32% were already taking PrEP and 44% reported intimate partner violence in the last 3 months. By the end of the 6-month intervention, 97% of the participants were retained in the study.
Compared with a control group, those in the intervention arm not already taking the medication were more likely to initiate PrEP, 52% vs. 24%; (adjusted RR = 2.28, 95% CI, 1.19-4.38). Those taking PrEP had a higher adherence, 25% vs. 13% (aRR = 1.86, 95% CI, 1.1-3.13).
Roberts and colleagues also reported a lower incidence of reported intimate partner violence in follow up (20%) and trends toward fewer intimate partner violence events and events resulting in injury.
“Our results showed that this approach appeared to be successful, at least in increasing uptake and adherence and potentially also reducing the rates of violence among participants,” Roberts said. “However, the rates of adherence that we observed were still quite low.”
Roberts noted that results from the early-stage pilot study would need to be confirmed in a larger study.
“If that study shows the same result and shows effectiveness, this intervention has the potential to expand PrEP uptake and adherence in this population, which again, is highly vulnerable to HIV and a real priority for ending the HIV epidemic.”
Roberts said it is essential to address relationship dynamics for young women when engaging them in discussion about HIV prevention.
“Directly providing male partners with information about PrEP and ensuring that they have information from a credible source to diffuse misconceptions and misunderstandings and stigma, and/or providing young women with the skills to engage their partners directly are both essential for facilitating successful PrEP use,” Roberts said.
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Roberts ST, et al. Safety and preliminary effectiveness of the Tu’Washindi intervention to increase PrEP use among Kenyan adolescent girls and young women at risk of intimate partner violence: a pilot cluster-randomized controlled trial. Presented at: International AIDS Conference; July 6-10, 2020 (virtual meeting).
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