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. 2021 Jun;33(6):712-720.
doi: 10.1080/09540121.2020.1822505. Epub 2020 Sep 21.

Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya

Jean de Dieu Tapsoba  1 , Sahar Z Zangeneh  1 , Eline Appelmans  1 , Siavash Pasalar  1 , Kira Mori  1 , Lily Peng  1 , Janice Tao  1 , Paul Drain  2 , Gordon Okomo  3 , Stanley Bii  4 , James Mukabi  5 , Stephanie Zobrist  6 , Martha Brady  6 , Rael Obanda  7 , Daniel Oluoch Madiang  7 , Jane Cover  6 , Ann Duerr  1 , Ying Qing Chen  1 , Christopher Obong'o  7
Affiliations

Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya

Jean de Dieu Tapsoba et al. AIDS Care. 2021 Jun.

Abstract

The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative aims to reduce HIV infections among adolescent girls and young women (AGYW) in Africa. Oral pre-exposure prophylaxis (PrEP) is offered through DREAMS in Kenya to eligible AGYW in high burden counties including Kisumu and Homa Bay. This study examines PrEP persistence among AGYW in high burden community-based PrEP delivery settings. We evaluated PrEP persistence among AGYW in the DREAMS PrEP program in Kisumu and Homa Bay using survival analysis and programmatic PrEP refill data collected between March through December 2017. Among 1,259 AGYW who initiated PrEP during the study period, the median persistence time in the program was 56 days (95% CI: 49-58 days) and the proportion who persisted 3 months later was 37% (95% CI: 34-40%). Persistence varied by county (p < 0.001), age at PrEP initiation (p = 0.002), marital status (p = 0.008), transactional sex (p = 0.002), gender-based violence (GBV) experience (p = 0.009) and current school attendance (p = 0.001) at DREAMS enrollment. Persistence did not vary with orphan status, food insecurity, condom use, age at first sexual encounter or engagement in age-disparate sex at DREAMS enrollment. Targeted strategies are needed to improve AGYW retention in the PrEP program.

Keywords: Adolescent girls and young women; DREAMS Initiative; HIV prevention; PrEP, survival analysis; persistence.

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Conflict of interest statement

Declaration of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Conceptual PrEP cascade for AGYW enrolled in the DREAMS program in Kisumu and Homa Bay counties, Kenya.
Figure 2.
Figure 2.
Overall PrEP persistence proportions (based on the Kaplan-Meier estimation method) at 1, 2 and 3 month(s) since PrEP initiation among AGYW (in DREAMS) who initiated PrEP between March 2017 and December 2017 in Kisumu and Homa Bay, counties, Kenya.
Figure 3.
Figure 3.
Kaplan-Meier PrEP persistence curves for AGYW (in DREAMS) who initiated PrEP between March 2017 and December 2017 in Kisumu and Homa Bay, counties, Kenya.
See this image and copyright information in PMC

References

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