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. 2023 Jun 16;23(1):1163.
doi: 10.1186/s12889-023-16081-0.

Feasibility and acceptability of peer-delivered HIV self-testing and PrEP for young women in Kampala, Uganda

Rita Nakalega  1 , Nelson Mukiza  2 , Robert Menge  3 , Samuel Kizito  4 , Juliet Allen Babirye  5 , Cynthia Ndikuno Kuteesa  2 , Denis Mawanda  2 , Emmie Mulumba  5 , Josephine Nabukeera  5 , Joseph Ggita  5 , Lydia Nakanjako  2 , Carolyne Akello  5 , Brenda Gati Mirembe  5 , Zubair Lukyamuzi  5 , Catherine Nakaye  5 , Hajira Kataike  5 , Joel Maena  5 , Juliane Etima  5 , Hadijah Kalule Nabunya  5 , Florence Biira  5 , Christine Nagawa  5 , Renee Heffron  6 , Connie Celum  6 , Monica Gandhi  7 , Andrew Mujugira  6   8
Affiliations

Feasibility and acceptability of peer-delivered HIV self-testing and PrEP for young women in Kampala, Uganda

Rita Nakalega et al. BMC Public Health. .

Abstract

Background: Adolescent girls and young women (AGYW) account for 29% of new HIV infections in Uganda despite representing just 10% of the population. Peer support improves AGYW linkage to HIV care and medication adherence. We evaluated the feasibility and acceptability of peer delivered HIV self-tests (HIVST) and oral pre-exposure prophylaxis (PrEP) to young women in Uganda.

Methods: Between March and September 2021, we conducted a pilot study of 30 randomly selected young women, aged 18-24 years, who had received oral PrEP for at least three months, but had suboptimal adherence as measured by urine tenofovir testing (< 1500 ng/ml). Participants were offered daily oral PrEP and attended clinic visits three and six months after enrollment. Between clinic visits, participants were visited monthly by trained peers who delivered HIVST and PrEP. Feasibility and acceptability of peer-delivered PrEP and HIVST (intervention) were measured by comparing actual versus planned intervention delivery and product use. We conducted two focus groups with young women, and five in-depth interviews with peers and health workers to explore their experiences with intervention delivery. Qualitative data were analyzed using thematic analysis.

Results: At baseline, all 30 enrolled young women (median age 20 years) accepted peer-delivered PrEP and HIVST. Peer delivery visit completion was 97% (29/30) and 93% (28/30) at three and six months, respectively. The proportion of participants with detectable tenofovir in urine was 93% (27/29) and 57% (16/28) at months three and six, respectively. Four broad themes emerged from the qualitative data: (1) Positive experiences of peer delivered HIVST and PrEP; (2) The motivating effect of peer support; (3) Perceptions of female controlled HIVST and PrEP; and (4) Multi-level barriers to HIVST and PrEP use. Overall, peer delivery motivated young women to use HIVST and PrEP and encouraged persistence on PrEP by providing non-judgmental client-friendly services and adherence support.

Conclusion: Peer delivery of HIVST and oral PrEP was feasible and acceptable to this sample of young women with suboptimal PrEP adherence in Uganda. Future larger controlled studies should evaluate its effectiveness among African AGWY.

Keywords: HIV; Oral PrEP; Peer delivery; Self-testing; Young women.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Acceptability and feasibility of peer delivered HIVST and PrEP
Fig. 2
Fig. 2
PrEP adherence during the study period. No Number, TFV Urine Tenofovir test
See this image and copyright information in PMC

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