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Trajectories of PrEP Adherence Among Young Women Aged 16 to 25 in Cape Town, South Africa

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Abstract

Despite demonstrated efficacy for HIV prevention, substantial challenges remain for the successful rollout of oral pre-exposure prophylaxis (PrEP), especially among adolescent girls and young women (AGYW). We characterized trajectories of PrEP adherence among 200 AGYW in South Africa and analyzed data from 22 qualitative interviews and 3 focus group discussions for explanatory purposes. Two adherence trajectory groups were identified: 52% with high early adherence that declined after month three and 48% with low adherence throughout. Adherence in the “consistently low” group was related to social support and logistical concerns, while the decrease in the “high declining” group corresponded to a change in the frequency of study visits from monthly to quarterly. PrEP support should be differentiated for those who need more frequent visits and adherence support initially versus later in PrEP use. Visits every month, when needed, should be considered for AGYW who need sustained support later into use.

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Acknowledgements

This study was funded by the NIH through Award Number R01MH107251. We would like to thank all of the young women who participated in this study and the study teams at the Desmond Tutu HIV Centre and the University of Washington.

Funding

The study was funded by the United States National Institute of Mental Health, Award MH10725

Author information

Authors and Affiliations

  1. Women’s Global Health Imperative, RTI International, 2150 Shattuck avenue, Berkeley, CA, 94104, USA

    Marie C. D. Stoner & Ariane van der Straten

  2. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Katherine B. Rucinski

  3. Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA

    Danielle Giovenco

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

    Danielle Giovenco, Katherine Gill & Linda-Gail Bekker

  5. Department of Global Health, University of Washington, Seattle, WA, USA

    Jennifer F. Morton & Connie L. Celum

  6. Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA

    Ariane van der Straten

Authors
  1. Marie C. D. Stoner
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  2. Katherine B. Rucinski
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  3. Danielle Giovenco
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  4. Katherine Gill
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  5. Jennifer F. Morton
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  6. Linda-Gail Bekker
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  7. Connie L. Celum
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  8. Ariane van der Straten
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Corresponding author

Correspondence to Marie C. D. Stoner.

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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. Other coauthors have no conflicts of interest.

Ethical Approval

The study protocol was approved by the Health Science ethics review committee at University of Cape Town.

Informed Consent

All participants provided written informed consent in English or Xhosa. A parental consent waiver was granted for participants ages 16–17.

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Appendix

Appendix

See Table 2.

Table 2 Model fit statistics for trajectory groups
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Stoner, M.C.D., Rucinski, K.B., Giovenco, D. et al. Trajectories of PrEP Adherence Among Young Women Aged 16 to 25 in Cape Town, South Africa. AIDS Behav 25, 2046–2053 (2021). https://doi.org/10.1007/s10461-020-03134-3

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