A study on the characteristics and associations of long-acting injectable PrEP among adolescent girls and young women seeking contraceptive care at pharmacies in Kenya: a cross-sectional analysis

Abstract

BackgroundHIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention, but barriers to access contribute to low initiation and continuation among adolescent girls and young women (AGYW) in Eastern and Southern Africa. Long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) has the potential to overcome adherence challenges associated with daily oral PrEP. Understanding willingness to switch to LA-PrEP among AGYW is crucial for informing product volume and demand generation strategies. Methods We conducted a cross-sectional secondary analysis of survey data from the AGYW Pharmacy PrEP Study, a cluster-randomized trial that enrolled AGYW seeking contraceptives at retail pharmacies in Kisumu County, Kenya. Our primary outcome was willingness to switch to LA-PrEP. We assessed frequency of willingness to switch, reasons for being willing or unwilling, and used univariate and multivariate Poisson regression to evaluate associations between demographic and behavioral characteristics and willingness to switch to LA-PrEP. Results Of 1,496 eligible AGYW, 66% were aged 20 to 24 (compared to 15 to 19), 74% completed secondary school, 18% were married, and 65% had only one primary partner. 67% reported being willing to switch to LA-PrEP, 26% reported they would not be willing to switch, and 7% said they were unsure. Most respondents initiated PrEP at enrollment (84%) and had a high HIV risk score (73%). Prevalence of willingness to switch to LA-PrEP was higher among respondents who purchased injectable contraceptives (aPR = 1.31, 95% CI: 1.1 – 1.58, p-value = 0.003), reported recent condomless sex (aPR = 1.2, 95% CI: 1.07–1.35, p-value = 0.002), and heard of oral PrEP before enrollment (aPR = 1.1, 95% CI: 1.01–1.19, p-value = 0.03). Conclusion Overall, willingness to switch to LA-PrEP was high. Educating AGYW about PrEP options and the risks and benefits of using LA-PrEP may increase uptake.