Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study

• DOI: 10.1371/journal.pmed.1004097
• Publication Date: 2022-09-12T17:46:47Z
• Authors: Jean de Dieu Tapsoba; Jane Cover; Christopher Obong’o; Martha Brady; Tim R. Cressey; Kira Mori; Gordon Okomo; Edward Kariithi; Rael Obanda; Daniel Oluoch-Mad...; Ying Qing Chen; Paul Drain; Ann Duerr
• Keywords: Pre-exposure prophylaxis; Emtricitabine; Attendance

Background In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent <10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) can be highly effective, low persistence PrEP programs poor adherence have limited its ability reduce incidence among women. Methods findings A total 336 AGYW participating PEPFAR-funded DREAMS program western Kenya were enrolled into a study use conducted between 6/2019 1/2020. AGYW, who used daily TDF/FTC, completed interviews provided dried blood spots (DBS) measurement tenofovir-diphosphate (TFV-DP) concentrations at enrollment 3 months later, 176/302 (58.3%, 95% confidence interval [95% CI 52.3 63.8]) met our definition persistence: having expressed intention attended both second interview an interim refill visit. Among DBS taken interview, only 9/197 (4.6%, 1.6 7.5]) had protective TFV-DP levels (≥700 fmol/punch) 163/197 (82.7%, 77.5 88]) consistent no recent (<10 fmol/punch). Perception being moderate-to-high risk if not taking was associated (adjusted odds ratio, 10.17 5.14 20.13], p < 0.001) model accounting county residence variables that -value <0.1 unadjusted analysis (age, school, initiated 2 before first still active DREAMS, children, multiple sex partners, partner aware use, very supportive has other believes puts her risk, male condom injectable contraceptive implant use). reported continuing PrEP, >90% indicated they using prevent HIV, although almost all non-protective levels. Limitations included short duration inclusion participants. Conclusions Many persisted without frequently enough receive benefit. Notably, higher self-perceived infection. These may optimal candidates long-acting PrEP.