Abstract
Background: While the introduction of HIV Pre-Exposure Prophylaxis (PrEP) as an HIV prevention strategy has allowed women to exercise more control over the reduction of HIV transmission rates, adolescent girls and young women in Sub-Saharan Africa continue to experience higher rates of HIV infections and bear the greatest disease burden. Understanding progress in PrEP uptake among adolescent girls and young women would enhance risk reduction in this vulnerable population. The Determined, Resilient, AIDS-Free, Mentored and Safe women (DREAMS) Initiative plays a key role in this risk reduction strategy. Methods: We performed a qualitative study to explore facilitators and barriers to PrEP implementation and assess factors effecting initiation and persistence on PrEP among adolescent girls and young women enrolled in the DREAMS Initiative at Pamoja Community Based Organization in Kisumu, Kenya. We conducted key informant interviews (n = 15) with Pamoja Community Based Organization staff, health care providers and community leaders. Additionally, we conducted focus group discussions with young women receiving PrEP and peer mentors (n = 40). We performed a directed content analysis using the Consolidated Framework for Implementation Research to organize the identified facilitators and barriers. Results: We found that the use of the safe space model, decentralization of PrEP support and delivery, peer mentors, effective linkage to local health care facilities, the sensitization of parents and male sexual partners, disclosure of PrEP use by beneficiaries, active stakeholder involvement and community engagement were among some of the facilitators to PrEP uptake. Barriers to PrEP implementation, initiation and persistence included stigma associated with the use of anti-retroviral drugs, drug side effects, frequent relocation of beneficiaries, limited resources for routine screening and medication monitoring, and a limited number of qualified health care workers for PrEP distribution and administration. Conclusion: Overall, the community roll-out of PrEP within the DREAMS Initiative was successful due to a number of key facilitating factors, which ultimately led to successful PrEP implementation, increased PrEP initiation and enhanced persistence among adolescent girls and young women. The identified barriers should be addressed so that a larger scale-up of PrEP roll-out is possible in the future.
| Original language | English (US) |
|---|---|
| Article number | 1284 |
| Journal | BMC public health |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| State | Published - Dec 2021 |
Funding
The authors would like to thank all of the Pamoja Community Based Organization staff members, DREAMS beneficiaries, Ministry of Health, Seme Sub-County, and village leaders who helped make this study a possibility. We would also like to acknowledge Winny Ochieng who assisted in data collection. We appreciate the discussion with Leah Neubauer, EdD, MA for her guidance with manuscript revision and editing. Lastly, we would like to thank Sera Young, MA, PhD for her oversight of this project. Funding for this research came from the from Institute for Global Health at Feinberg School of Medicine at Northwestern University. Additionally, the research reported in this publication was supported by the Fogarty International Center and National Institute of Mental Health, of the National Institutes of Health under Award Number D43 TW010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- Adolescent girls and young women
- Consolidated framework for implementation research
- DREAMS initiative
- HIV pre-exposure prophylaxis
- Kenya
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
