Evaluation of depressive symptoms, HIV vulnerability, and oral PrEP uptake and adherence among adolescent girls and young women in Western Kenya: a cross-sectional study

Abstract

IntroductionThe mental health and well-being of individuals vulnerable to HIV acquisition are essential to achieving the maximum benefits of HIV prevention services including oral pre-exposure prophylaxis (PrEP). Yet, very little attention has been given to the role of mental health in HIV preventive interventions, especially among adolescent girls and young women (AGYW) in sub-Saharan Africa. We evaluated the relationship between depressive symptoms, HIV vulnerability, and oral PrEP uptake and adherence among Kenyan AGYW). Methods We conducted a cross-sectional study among AGYW participating in the Kenya Single-dose HPV vaccine-Efficacy (KEN SHE) Study, an ongoing randomized double-blinded prospective trial. We enrolled HIV-negative AGYW who attended follow-up visits in Kisumu between November 2023 and February 2024, excluding those who were within 42 days postpartum, older than 24 years and known to have or be undergoing treatment for a mental health disorder. Study staff administered questionnaires on demographics, depressive symptoms (using the PHQ-9), and HIV vulnerability. Data on oral PrEP were extracted from the parent study database. We used descriptive statistics and multivariable logistic regression to explore associations with moderate to severe depressive symptoms (PHQ-9 ≥10). We evaluated the associations of moderate to severe depressive symptoms with HIV vulnerability factors and oral PrEP uptake and adherence. Results We enrolled 300 AGYW with a median age of 21 years (range 19-24). Overall 78% had at least high school education and 67% reported having been ever pregnant. The prevalence of moderate to severe depressive symptoms was 14.3% (95% confidence interval [CI] 10.5%-18.8%). AGYW who perceived their HIV risk as medium had increased odds (aOR= 3.23, 95%CI 1.29-8.25) of experiencing moderate to severe depressive symptoms, compared to those who reported not knowing about their risk. Additionally, AGYW who engaged in transactional sex (aOR 3.82, 95% CI 1.06-13.00), had a history of pregnancy (aOR 2.81, 95% CI 1.20-7.00), and had completed post-primary education (aOR 3.43, 95% CI 1.13-13.00) had increased odds of having moderate to severe depressive symptoms. Oral PrEP uptake was low at 19.3% (n=58, 95%CI 15.0%-24.0%). Among those taking PrEP, 43.0% reported taking at least 5 doses in the past week (n=25, 95%CI, 30.1%-56.7%). The presence of moderate to severe depressive symptoms did not predict oral PrEP uptake (OR= 1.12 95%CI 0.48-2.41), including after adjustment for potential confounders (aOR =1.01 95%CI 0.39-2.41). While the prevalence of moderate to severe depressive symptoms was lower in the group adherent to oral PrEP than in the non-adherent group this difference was not significant (8.0% vs 18.2%, p=0.44). Conclusion Our study findings demonstrate a relatively high prevalence (14%) of moderate to severe depressive symptoms among AGYW in western Kenya. AGYW who reported a medium risk of perception of HIV, those who had been pregnant once, those who engaged in transactional sex, and those who had completed post-primary education were more likely to report moderate to severe depressive symptoms, highlighting the need to integrate mental health assessment and support into HIV prevention services.