Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda.
International AIDS Vaccine Initiative (IAVI), 125 Broad Street, 9th Floor, 10004, New York, NY, USA.
BMC Womens Health. 2022 Nov 10;22(1):440. doi: 10.1186/s12905-022-02018-z.
There is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda.
This study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14-24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM).
PrEP uptake and adherence were facilitated by factors including: perceptions that one's own or partner's sexual behaviour was high risk, a negative attitude towards condoms, social support and wanting to maintain a negative HIV status after receiving a negative HIV test result. Good adherence to PrEP was enabled by effective counselling, support tools such as alarms and phone reminders and incentives like free treatment for STIs and other illnesses during study visits. Barriers to uptake included: anxiety about the pill burden, perceptions of being too young for PrEP and fear of being labelled prostitute' or HIV positive'. Poor adherence was attributed to doubt over the efficacy of PrEP as a result of beliefs that because HIV was incurable, no medicine could prevent it. Alcohol use, side effects experienced, and mobility all had a negative impact on adherence. The majority of PrEP users reported feeling safe as a result of using PrEP which had both good and negative implications on their sexual behaviour, specifically the number of sexual partners and condom use.
Addressing community misconceptions to maximize uptake of PrEP among AGYW is important. Targeted education messages, and counselling to address misconceptions in ways that capture the attention of AGYW in communities are required.
关于影响青少年女孩和年轻女性（AGYW）接受和坚持口服暴露前预防（PrEP）的因素，信息有限。我们进行了一项定性方法研究，以探索在乌干达坎帕拉有感染人类免疫缺陷病毒（HIV）风险的 AGYW 中，接受 PrEP 和坚持使用 PrEP 的经验、促进因素和障碍。
本研究嵌套在一项前瞻性队列研究中，该研究为 AGYW 提供每日口服 PrEP。2019 年 4 月至 2020 年 10 月，我们对 26 名年龄在 14-24 岁之间的 AGYW 进行了深入访谈，这些 AGYW 要么已经接受了 PrEP 治疗，要么已经使用 PrEP 至少 6 个月，包括 PrEP 坚持者（8 名）、非坚持者（8 名）和拒绝 PrEP 者（10 名）。12 个月后，对 12 名坚持使用 PrEP 和放弃 PrEP 的 AGYW 进行了随访访谈。进行了主题分析，进一步检查和分类为社会生态模型（SEM）的 5 个构念。
PrEP 的接受和坚持是由以下因素促进的：认为自己或伴侣的性行为风险高、对避孕套的负面态度、社会支持以及在收到 HIV 检测结果呈阴性后希望保持 HIV 阴性状态。有效的咨询、警报和电话提醒等支持工具以及在研究访问期间免费治疗性传播感染和其他疾病等激励措施，使 PrEP 的良好坚持成为可能。接受 PrEP 的障碍包括：对药丸负担的焦虑、认为自己太年轻不适合接受 PrEP 以及担心被贴上“妓女”或“HIV 阳性”的标签。由于相信 HIV 是无法治愈的，没有药物可以预防，因此对 PrEP 疗效的怀疑导致了对 PrEP 的不良坚持。饮酒、经历的副作用和流动性都对坚持产生了负面影响。大多数 PrEP 用户表示由于使用 PrEP 感到安全，这对他们的性行为既有好的影响，也有坏的影响，特别是性伴侣的数量和避孕套的使用。
解决社区的误解以最大限度地提高 AGYW 对 PrEP 的接受度很重要。需要有针对性的教育信息，并以吸引社区中 AGYW 注意力的方式进行咨询，以解决误解。
