Martin Catherine E, Cox Laura Ashleigh, Nongena Pelisa, Butler Vusile, Ncube Sydney, Sawry Shobna, Mullick Saiqa
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
Wits RHI, University of the Witwatersrand, Johannesburg, South Africa.
J Adolesc Health. 2023 Dec;73(6S):S81-S91. doi: 10.1016/j.jadohealth.2023.08.004.
PURPOSE: This study describes the patterns of pre-exposure prophylaxis (PrEP) use among adolescent girls and young women (AGYW) initiated on daily oral PrEP for the prevention of HIV, within routine sexual and reproductive health services in South Africa. METHODS: We analysed clinical and survey data from a nested cohort of 967 AGYW initiated on oral PrEP between January 2019 and December 2021 in four geographical clusters in South Africa. We describe the periods of PrEP use, and the proportion who discontinued and subsequently restarted PrEP. Logistic regression analyses were conducted to determine factors associated with early PrEP discontinuation, PrEP use for ≥4 months and PrEP restart. RESULTS: PrEP use for ≤1 month was high (68.6%), although 27% returned and restarted PrEP; and 9% restarted more than once. Initiating PrEP at a mobile clinic (AOR 2.10, 95% CI 1.51 - 2.93) and having a partner known to be HIV negative or whose HIV status was unknown (AOR 7.11, 95% CI 1.45 - 34.23; AOR 6.90, 95% CI 1.44 - 33.09) were associated with PrEP use for ≤1 month. AGYW receiving injectable contraceptives were more likely to restart PrEP (AOR 1.61, 95% CI 1.10 - 2.35). Compared to those aged 15-17 years, participants 18 - 20 and 21 - 24 years were less likely to restart PrEP (AOR 0.51, 95% CI 0.35 - 0.74; AOR 0.60, 95%, CI 0.41 - 0.87), as were those initiating PrEP at a mobile clinic compared to a fixed facility (AOR 0.66, 95% CI 0.47 - 0.92). DISCUSSION: Although early PrEP discontinuation was high, it appears that PrEP use is frequently cyclical in nature. Further research is needed to determine if these cycles of PrEP correlate to periods of perceived or actual vulnerability to HIV, which may also be cyclical. PrEP delivery presents a unique opportunity to address multiple unmet health needs of young people.
目的：本研究描述了在南非常规性与生殖健康服务中，开始每日口服暴露前预防（PrEP）以预防艾滋病毒的青春期女孩和年轻女性（AGYW）中PrEP的使用模式。 方法：我们分析了2019年1月至2021年12月期间在南非四个地理区域开始口服PrEP的967名AGYW的嵌套队列的临床和调查数据。我们描述了PrEP的使用时间段，以及停药并随后重新开始使用PrEP的比例。进行逻辑回归分析以确定与早期停用PrEP、使用PrEP≥4个月和重新开始使用PrEP相关的因素。 结果：PrEP使用时间≤1个月的比例很高（68.6%），尽管27%的人返回并重新开始使用PrEP；9%的人不止一次重新开始使用。在流动诊所开始使用PrEP（调整后比值比[AOR]2.10，95%置信区间[CI]1.51 - 2.93）以及有已知为艾滋病毒阴性或艾滋病毒状况未知的伴侣（AOR 7.11，95%CI 1.45 - 34.23；AOR 6.90，95%CI 1.44 - 33.09）与PrEP使用时间≤1个月相关。接受注射用避孕药的AGYW更有可能重新开始使用PrEP（AOR 1.61，95%CI 1.10 - 2.35）。与15 - 17岁的参与者相比，18 - 20岁和21 - 24岁的参与者重新开始使用PrEP的可能性较小（AOR 0.51，95%CI 0.35 - 0.74；AOR 0.60，95%CI 0.41 - 0.87），在流动诊所开始使用PrEP的人与在固定机构开始使用的人相比也是如此（AOR 0.66，95%CI 0.47 - 0.92）。 讨论：尽管早期停用PrEP的比例很高，但PrEP的使用似乎本质上经常是周期性的。需要进一步研究以确定这些PrEP周期是否与感知到的或实际的艾滋病毒易感性时期相关，而这些时期也可能是周期性的。PrEP的提供为满足年轻人多种未满足的健康需求提供了一个独特的机会。
J Int AIDS Soc. 2025-2
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