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The PrEP Journey: Understanding How Internal Drivers and External Circumstances Impact The PrEP Trajectory of Adolescent Girls and Young Women in Cape Town, South Africa

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Abstract

Despite high risk for HIV, South African adolescent girls and young women (AGYW) experience numerous challenges with adherence to PrEP. To better understand AGYW’s motivations for PrEP and factors that impact PrEP adherence, we conducted serial in-depth interviews with 22 South African AGYW during a 12 month prospective study. Interviews explored motivations and initial experiences of PrEP use, patterns of adherence, social support, and reasons for stopping or persisting with PrEP. We also assessed drug levels as a biomarker of adherence; dried blood spots were collected at months 1, 2, 3, 6, and 12 to assess intracellular tenofovir diphosphate levels. An end-user journey analytical approach revealed themes related to behavioral and emotional aspects of use, including multilevel factors leading to divergent PrEP adherence trajectories. Our findings highlight how internal versus external motivations drive PrEP use, as well as how positive identity formation and challenges are handled, which are essential to understand AGYW in their PrEP journeys.

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Notes

  1. http://www.engagehcd.com/dpv-ring/ [note that the journey map is in the asset folder library 1]

References

  1. UNAIDS. Miles to go: closing gaps, breaking barriers, righting injustices. Geneva: Joint UN Programme on HIV/AIDS; 2018.

  2. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic. Geneva; 2013.

  3. UNAIDS. The Gap Report. Switzerland; 2014.

  4. UNAIDS. South Africa: Country Overview. 2018.

  5. Ahmed K, Baeten JM, Beksinska M, Bekker L-G, Bukusi EA, Donnell D, et al. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial. Lancet. 2019;394(10195):303–13.

    Article  Google Scholar 

  6. Donnell D, Baeten JM, Bumpus NN, Brantley J, Bangsberg DR, Haberer JE, et al. HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J Acquir Immune Defic Syndr. 2014;66(3):340–8.

    Article  CAS  Google Scholar 

  7. Celum CL, Delany-Moretlwe S, Baeten JM, van der Straten A, Hosek S, Bukusi EA, et al. HIV pre-exposure prophylaxis for adolescent girls and young women in Africa: from efficacy trials to delivery. J Int AIDS Soc. 2019;22(Suppl 4):e25298.

    PubMed  PubMed Central  Google Scholar 

  8. Hanscom B, Janes HE, Guarino PD, Huang Y, Brown ER, Chen YQ, et al. Brief report: preventing HIV-1 infection in women using oral preexposure prophylaxis: a meta-analysis of current evidence. J Acqu Immune Defic Syndr. 2016;73(5):606–8.

    Article  Google Scholar 

  9. Celum C, Mgodi N, Bekker L, Hosek S, Donnell D, Anderon P, editors. Adherence 3 months after PrEP initiation among young African women in HPTN 082. Conference on Retroviruses and Opportunistic Infections (CROI); 2019.

  10. Amico KR, Mansoor LE, Corneli A, Torjesen K, van der Straten A. Adherence support approaches in biomedical HIV prevention trials: experiences, insights and future directions from four multisite prevention trials. AIDS Behav. 2013;17(6):2143–55.

    Article  Google Scholar 

  11. van der Straten A, Montgomery ET, Musara P, Etima J, Naidoo S, Laborde N, et al. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS (London, England). 2015;29(16):2161–71.

    Article  Google Scholar 

  12. Ndase P, Celum C, Campbell J, Bukusi E, Kiarie J, Katabira E, et al. Successful discontinuation of the placebo arm and provision of an effective HIV prevention product after a positive interim efficacy result: the partners PrEP study experience. J Acquir Immune Defic Syndr. 2014;66(2):206–12.

    Article  Google Scholar 

  13. Gomez A, Malone S, Prasad R, Gangaramany A, Croucamp Y, Mulhausen J, et al. Understanding HIV prevention in high- risk adolescent girls and young women in two South African provinces. South African Health Review; 2019:167-72.

  14. Albert D, Chein J, Steinberg L. Peer influences on adolescent decision making. Curr Dir Psychol Sci. 2013;22(2):114–20.

    Article  Google Scholar 

  15. Okonkwo PI, Fatusi AO, Ilika AL. Perception of peers’ behaviour regarding sexual health decision making among female undergraduates in Anambra State Nigeria. African Health Sci. 2005;5(2):107–13.

    CAS  Google Scholar 

  16. Tomé G, Matos M, Simões C, Diniz JA, Camacho I. How can peer group influence the behavior of adolescents: explanatory model. Glob J Health Sci. 2012;4(2):26–35.

    Article  Google Scholar 

  17. Roberts ST, Khoza N, Rousseau-Jemwa E, Omollo V, Morton J, Bekker LG, et al. “As long as my mother supports me, then I am okay”: Family influences on oral PrEP use among adolescent girls and young women in Kenya and South Africa. Adherence Conference; June 17-19, 2019; Miami, Florida.

  18. Celum C, Gill K, Morton J, Stein G, Myers L, Thomas K, et al. Incentives conditioned on tenofovir levels to support adherence among young South African women: a randomized trial. Journal of the International AIDS Society. 2020 (publication forthcoming).

  19. MASICORP. About Masiphumelele: Health- TB and HIV 2018. https://www.masicorp.org/masicorp/about-masiphumelele/.

  20. City of Cape Town – 2011 Census Suburb Masiphumelele [Internet]. 2011. http://resource.capetown.gov.za/documentcentre/Documents/Maps%20and%20statistics/2011_Census_CT_Suburb_Masiphumelele_Profile.pdf.

  21. Morton JF, Myers L, Gill K, Bekker L-G, Stein G, Thomas KK, et al. Evaluation of a behavior-centered design strategy for creating demand for oral PrEP among young women in Cape Town, South Africa. Gates Open Research; 2020,4.

  22. Tolley E. Traditional Socio-Behavioral Research and Human-Centered Design: Similarities, Unique Contributions and Synergies. FHI 360 December 31;2017.

  23. Stern E, Clarfelt A, Buikema R. The use of sexual history narratives to assess processes of hegemonic masculinity among south african men in the context of HIV/AIDS. Men Masculinit. 2014;18(3):340–62.

    Article  Google Scholar 

  24. Srivastava A, Thomson SB. Framework analysis: a qualitative methodology for applied policy research. J Administr Governance. 2009;4(2):72–9.

    Google Scholar 

  25. Bradley H, Tsui A, Hindin M, Kidanu A, Gillespie D. Developing scales to measure perceived HIV risk and vulnerability among Ethiopian women testing for HIV. AIDS Care. 2011;23(8):1043–52.

    Article  Google Scholar 

  26. Larson RW, Rusk N. Chapter 5 - Intrinsic Motivation and Positive Development. In: Lerner RM, Lerner JV, Benson JB, editors. Advances in Child Development and Behavior. 41: JAI; 2011, 89-130.

  27. West R, Michie S, Rubin GJ, Amlôt R. Applying principles of behaviour change to reduce SARS-CoV-2 transmission. Nat Human Behav. 2020;4(5):451–9.

    Article  Google Scholar 

  28. Stadler J, Scorgie F, van der Straten A, Saethre E. Adherence and the lie in a HIV prevention clinical trial. Med Anthropol. 2016;35(6):503–16.

    Article  Google Scholar 

  29. Katz AW, Mensch BS, Woeber K, Musara P, Etima J, van der Straten A. Understanding women’s motivations to participate in MTN-003/VOICE, a phase 2b HIV prevention trial with low adherence. BMC Women’s Health. 2019;19(1):18.

    Article  Google Scholar 

  30. Hartmann M, McConnell M, Bekker LG, Celum C, Bennie T, Zuma J, et al. Motivated reasoning and hiv risk? views on relationships, trust, and risk from young women in cape town, south africa, and implications for oral PrEP. AIDS Behav. 2018;22(11):3468–79.

    Article  Google Scholar 

  31. van der Straten A, Stadler J, Luecke E, Laborde N, Hartmann M, Montgomery ET. Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE-C qualitative study in Johannesburg, South Africa. J Int AIDS Soc. 2014;17(3 Suppl 2):19146.

    PubMed  PubMed Central  Google Scholar 

  32. van der Straten A, Stadler J, Montgomery E, Hartmann M, Magazi B, Mathebula F, et al. Women’s experiences with oral and vaginal pre-exposure prophylaxis: the VOICE-C qualitative study in Johannesburg, South Africa. PloS One. 2014;9(2):e89118.

    Article  Google Scholar 

  33. Amico KR, Wallace M, Bekker LG, Roux S, Atujuna M, Sebastian E, et al. Experiences with HPTN 067/ADAPT study-provided open-label PrEP among women in cape town: facilitators and barriers within a mutuality framework. AIDS Behav. 2017;21(5):1361–75.

    Article  Google Scholar 

  34. Velloza J, Khoza N, Scorgie F, Chitukuta M, Mutero P, Mutiti K, et al. The influence of HIV-related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study. J Int AIDS Soc. 2020;23(3):e25463.

    Article  Google Scholar 

  35. Guest G, Bunce A, Johnson L. How many interviews are enough?: An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.

    Article  Google Scholar 

  36. Hartmann M, Lanham M, Palanee-Phillips T, Mathebula F, Tolley EE, Peacock D, et al. Generating CHARISMA: development of an intervention to help women build agency and safety in their relationships while using PrEP for HIV prevention. AIDS Educ Prev. 2019;31(5):433–51.

    Article  Google Scholar 

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Acknowledgements

We would like to thank Dr Eve Mendel, Jacqui Dallimore, Lauren Fynn, Ntombomzi Mcanjana, the study team for the passion and care they put into this study, and the young women who participated in this study. This study was supported by the National Institutes of Health (1R01MH107251). Writing of this manuscript was supported in part by internal funds from RTI International. The content is solely the responsibility of the authors and does not necessarily represent the official views of the authors’ employers or funders.

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Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 2150 Shattuck Avenue, #800, Berkeley, CA, 94704, USA

    Shannon O’Rourke, Miriam Hartmann & Ariane van der Straten

  2. Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa

    Laura Myers, Nosiphiwo Lawrence, Katherine Gill & Linda-Gail Bekker

  3. University of Washington, Seattle, WA, USA

    Jennifer F. Morton & Connie L. Celum

  4. Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA

    Ariane van der Straten

  5. ASTRA consulting, Kensington, CA, 94708, USA

    Ariane van der Straten

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  1. Shannon O’Rourke
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  2. Miriam Hartmann
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Correspondence to Ariane van der Straten.

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Conflict of interest

Dr. Connie Celum reports grants from NIH and has served as a scientific advisor to Merck and Gilead Science.

Ethical Approval

The study protocol was reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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O’Rourke, S., Hartmann, M., Myers, L. et al. The PrEP Journey: Understanding How Internal Drivers and External Circumstances Impact The PrEP Trajectory of Adolescent Girls and Young Women in Cape Town, South Africa. AIDS Behav 25, 2154–2165 (2021). https://doi.org/10.1007/s10461-020-03145-0

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