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The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa

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Abstract

Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.

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Data Availability

Data is available upon request from Dr. Wendee Wechsberg.

Code Availability

Not applicable.

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Funding

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R01HD094629; PI: Wechsberg). The funders had no role in the study design, data collection, analysis, or interpretation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA

    Courtney Peasant Bonner, Jacqueline W. Ndirangu, Felicia A. Browne & Wendee M. Wechsberg

  2. Women’s Global Health Imperative, RTI International, NC, USA

    Alexandra M. Minnis & Laura Nyblade

  3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Ilene Speizer

  4. Setshaba Research Centre, Soshanguve, South Africa

    Khatija Ahmed

  5. Faculty of Health Sciences, Dept of Medical Microbilogy, University of Pretoria, Pretoria, South Africa

    Khatija Ahmed

Authors
  1. Courtney Peasant Bonner
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  3. Jacqueline W. Ndirangu
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  4. Felicia A. Browne
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  8. Wendee M. Wechsberg
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Contributions

CPB and AMM led the analysis and writing of the manuscript. WW contributed to the writing of the background, methods, and discussion sections. FAB, KA, JWN, IS, LN, and WW reviewed and provided critical feedback.

Corresponding author

Correspondence to Courtney Peasant Bonner.

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Conflict of Interest

The authors have no conflicts of interest to disclose.

Ethics Approval

This study was approved by the ethics review committees of the South African Medical Association Research Ethics Committee, which served as the Institutional Review Board (IRB) of Record, and by the Tshwane District Health Research Committee and the Skills Development for Tshwane Municipal Clinics.

Consent to Participate

All participants provided written informed consent (or assent, if aged 16 or 17) prior to data collection.

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Not applicable.

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Bonner, C.P., Minnis, A.M., Ndirangu, J.W. et al. The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa. AIDS Behav 27, 4124–4130 (2023). https://doi.org/10.1007/s10461-023-04126-9

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