Understanding the influence of Socio-ecological Factors on Preexposure Prophylaxis (PrEP) use in Adolescent Girls and Young Women in Africa

Abstract

University of Washington Abstract Understanding the influence of Socio-ecological Factors on Preexposure Prophylaxis (PrEP) use in Adolescent Girls and Young Women in Africa Geetha Beauchamp Co-Chairs of Supervisory Committee:Kwun Chan, and Deborah Donnell Department of Health Systems and Population Health African adolescent girls and young women (AGYW) have one of the highest global HIV incidence rates despite increased access to highly effective oral preexposure prophylaxis (PrEP) for prevention, HIV testing, and linkage-to-care/viral suppression among men. Inconsistent PrEP adherence undermines PrEP benefits for AGYW. Qualitative research suggests that barriers to PrEP adherence include fear of disclosure of PrEP use, stigma, provider distrust, and poor social support. A reliable tool for predicting AGYW’s “PrEP readiness” would help identify who could benefit from greater PrEP adherence support. An improved understanding of the pathways affecting AGYW’s adherence is crucial to advancing adherence strategies. This research used data from the open-label HPTN 082 study conducted among AGYW (ages16-25 years) in South Africa and Zimbabwe. The HIV Prevention Readiness Measure (HPRM) questionnaire was adapted from the validated HIV Treatment Readiness Measure, which predicted viral suppression in HIV-positive youth in the U.S. The HPRM was administered to HPTN 082 participants at enrollment and again three months later. The aims of this research were to 1) evaluate the psychometric properties and the utility of the HPRM to predict PrEP adherence; 2) investigate the association between PrEP disclosure and adherence and whether it was moderated by social support and mediated through PrEP support; and 3) assess whether mistrust in the study team was associated with discordance between patient-reported PrEP adherence and an objective biomarker of PrEP adherence, intracellular tenofovir-diphosphate drug concentrations. The findings were: 1) overall HPRM score and the three subscales (self-efficacy, disclosure of PrEP use, and social support) are reliable and predicted increased PrEP adherence; and disclosure of PrEP use increased the odds of persistent adherence; 2) AGYW with supportive adults in their life and disclosed PrEP use to their parents had higher adherence; and 3) AGYW who expressed high trust in their providers had higher odds of both high self-reported and drug level measures of PrEP adherence. The research makes three significant contributions to improving PrEP delivery: 1) HPRM as a tool to assess PrEP readiness and focus adherence support on AGYW who have low self-efficacy, low social support, and no plans for disclosing PrEP use; 2) supporting AGYW to consider disclosing their PrEP use to the supportive adults in their lives; and 3) in provider PrEP training, discuss the importance of AGYW’s trust in their provider as essential to improving AGYW reporting actual PrEP use.