Acceptability and utility of a decision support tool in enabling young women to make informed choices about PrEP options

Abstract

Introduction: Adolescent girls and young women (AGYW) in Sub-Saharan Africa remain at high risk for HIV infection yet their uptake of, and persistence on HIV pre-exposure prophylaxis (PrEP) remains a challenge. With increasing availability of different HIV PrEP formulations, a decision support tool (DST) could improve AGYWs’ risk perception and increase their PrEP knowledge to enable them make informed decisions about PrEP.Methods: We evaluated the updated MyPrEP, a client-facing DST about oral PrEP and HIV prevention, with modules on daily oral emtricitabine-tenofovir, monthly dapivirine vaginal ring (DVR) and bi-monthly injectable cabotegravir. From August to December 2022, sexually active, HIV-uninfected AGYW from six African countries (Eswatini, Kenya, Malawi, South Africa, Uganda, Zambia) were enrolled in a prospective cohort with oral emtricitabine-tenofovir offered to all participants and 6 months of follow-up. At month 6, we evaluated preferences for these different PrEP formulations among AGYW, with dapivirine ring and bimonthly injectable cabotegravir only available in research projects. We ran multivariable logistic models to determine participant characteristics associated with preference, increased knowledge and interest in these PrEP formulations. Results: Of 2795 AGYW with a median age of 24 years (interquartile range [IQR] 21,27) 74.9% were from South Africa, 95.6% had a primary sex partner with 22.8% having multiple sex partners. At enrollment, 93% initiated oral PrEP and based on month 6 urine tenofovir testing which indicated use in the prior week, approximately 70% of participants demonstrated recent oral PrEP use. Injectable PrEP was most preferred at 52.8%, monthly oral PrEP at 31.5%, daily oral PrEP at 25.5%, with DVR being least preferred at 5.4%. Compared to AGYW with poor adherence, AGYW with self-reported good adherence to oral PrEP had 2.22 times higher odds of preferring daily oral PrEP (aOR= 2.22, 95%CI: 1.54,3.20) while those with fair adherence had 51% lower odds (aOR= 0.49, 95% CI: 0.28, 0.87) of preferring DVR. Similar proportions of participants reported increased knowledge about oral and injectable PrEP (67.3% and 66.3% respectively) after using the DST. Almost 90% of AGYW strongly liked getting information about PrEP from the DST. Conclusion: AGYW revealed a strong preference for long-acting PrEP formulations after using the My PrEP DST which overall increased participants’ interest and knowledge about PrEP formulations. With increasing availability of different PrEP formulations, innovative tools like My PrEP DST could facilitate AGYW’s ability to assess their HIV risk and make informed choices about PrEP.