Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context
Summary: Background: Adolescent girls and young women (AGYW) in East and southern Africa experience a disproportionate burden of HIV incidence. Integrating HIV pre-exposure prophylaxis (PrEP) within existing programs is a key component of addressing this disparity. Methods: We evaluated an oral PrE...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S258953702300593X |
| _version_ | 1797348634077954048 |
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| author | Yasaman Zia Lydia Etyang Bernard Nyerere Cyprian Nyamwaro Felix Mogaka Margaret Mwangi Lavender June Roy Njiru Job Mokoyo Susan Kimani Katherine K. Thomas Kenneth Ngure Inviolata Wanyama Elizabeth Bukusi Nelly Mugo Renee Heffron |
| author_facet | Yasaman Zia Lydia Etyang Bernard Nyerere Cyprian Nyamwaro Felix Mogaka Margaret Mwangi Lavender June Roy Njiru Job Mokoyo Susan Kimani Katherine K. Thomas Kenneth Ngure Inviolata Wanyama Elizabeth Bukusi Nelly Mugo Renee Heffron |
| author_sort | Yasaman Zia |
| collection | DOAJ |
| description | Summary: Background: Adolescent girls and young women (AGYW) in East and southern Africa experience a disproportionate burden of HIV incidence. Integrating HIV pre-exposure prophylaxis (PrEP) within existing programs is a key component of addressing this disparity. Methods: We evaluated an oral PrEP program integrated into post-abortion care (PAC) in Kenya from March 2021 to November 2022. Technical advisors trained staff at PAC clinics on PrEP delivery, abstracted program data from each clinic, and collected data on structural characteristics. Utilizing a modified Poisson regression, we estimated the effect of structural factors on the probability of PrEP offer and uptake. Findings: We abstracted data on 6877 AGYW, aged 15–30 years, across 14 PAC clinics. PrEP offers were made to 57.4% of PAC clients and 14.1% initiated PrEP. Offers were associated with an increased probability at clinics that had consistent supply of PrEP (relative risk (RR):1.81, 95% CI: 1.1–2.95), inconsistent HIV testing commodities (RR: 1.89, 95% CI: 1.29–2.78), had all providers trained (RR: 1.65, 95% CI: 1.01, 2.68), and were public (RR: 1.89, 95% CI: 1.29–2.78). These same factors were associated with PrEP uptake: consistent supply of PrEP (RR: 2.71, 95% CI: 1.44–5.09), inconsistent HIV testing commodities (RR: 2.55, 95% CI: 1.39–4.67), all providers trained (RR: 2.61, 95% CI: 1.38–4.92), and were public (RR: 2.55, 95% CI: 1.39–4.67). Interpretation: Greater success with integration of HIV prevention into reproductive health services will likely require investments in systems, such as human resources and PrEP and HIV testing commodities, to create stable availability and ensure consistent access. Funding: PrEDIRA 2 was supported by funding from Children's Investment Fund Foundation (R-2001-04433). Ms. Zia was funded by the NIH Ruth L. Kirchstein pre-doctoral award (5F31HD105494-02) and Dr. Heffron was funded by National Institute of Mental Health (K24MH123371). |
| first_indexed | 2024-03-08T12:08:36Z |
| format | Article |
| id | doaj.art-526236e28eaa4000b2584342e88eb154 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-08T12:08:36Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-526236e28eaa4000b2584342e88eb1542024-01-23T04:16:05ZengElsevierEClinicalMedicine2589-53702024-02-0168102416Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in contextYasaman Zia0Lydia Etyang1Bernard Nyerere2Cyprian Nyamwaro3Felix Mogaka4Margaret Mwangi5Lavender June6Roy Njiru7Job Mokoyo8Susan Kimani9Katherine K. Thomas10Kenneth Ngure11Inviolata Wanyama12Elizabeth Bukusi13Nelly Mugo14Renee Heffron15Department of Epidemiology, University of Washington, USA; Department of Global Health, University of Washington, USACenter for Clinical Research, Kenya Medical Research Institute, KenyaCenter for Microbiology Research, Kenya Medical Research Institute, KenyaMarie Stopes Kenya, KenyaCenter for Microbiology Research, Kenya Medical Research Institute, KenyaCenter for Clinical Research, Kenya Medical Research Institute, KenyaCenter for Microbiology Research, Kenya Medical Research Institute, KenyaCenter for Clinical Research, Kenya Medical Research Institute, KenyaMarie Stopes Kenya, KenyaMarie Stopes Kenya, KenyaDepartment of Global Health, University of Washington, USADepartment of Global Health, University of Washington, USA; School of Public Health, Jomo Kenyatta University of Agriculture and Technology, KenyaMarie Stopes Kenya, KenyaDepartment of Global Health, University of Washington, USA; Center for Microbiology Research, Kenya Medical Research Institute, KenyaDepartment of Global Health, University of Washington, USA; Center for Clinical Research, Kenya Medical Research Institute, KenyaDepartment of Epidemiology, University of Washington, USA; Department of Global Health, University of Washington, USA; Department of Medicine, University of Alabama at Birmingham, USA; Corresponding author. 845 19th Street South/BBRB 256, Birmingham, Alabama 35294-2170, USA.Summary: Background: Adolescent girls and young women (AGYW) in East and southern Africa experience a disproportionate burden of HIV incidence. Integrating HIV pre-exposure prophylaxis (PrEP) within existing programs is a key component of addressing this disparity. Methods: We evaluated an oral PrEP program integrated into post-abortion care (PAC) in Kenya from March 2021 to November 2022. Technical advisors trained staff at PAC clinics on PrEP delivery, abstracted program data from each clinic, and collected data on structural characteristics. Utilizing a modified Poisson regression, we estimated the effect of structural factors on the probability of PrEP offer and uptake. Findings: We abstracted data on 6877 AGYW, aged 15–30 years, across 14 PAC clinics. PrEP offers were made to 57.4% of PAC clients and 14.1% initiated PrEP. Offers were associated with an increased probability at clinics that had consistent supply of PrEP (relative risk (RR):1.81, 95% CI: 1.1–2.95), inconsistent HIV testing commodities (RR: 1.89, 95% CI: 1.29–2.78), had all providers trained (RR: 1.65, 95% CI: 1.01, 2.68), and were public (RR: 1.89, 95% CI: 1.29–2.78). These same factors were associated with PrEP uptake: consistent supply of PrEP (RR: 2.71, 95% CI: 1.44–5.09), inconsistent HIV testing commodities (RR: 2.55, 95% CI: 1.39–4.67), all providers trained (RR: 2.61, 95% CI: 1.38–4.92), and were public (RR: 2.55, 95% CI: 1.39–4.67). Interpretation: Greater success with integration of HIV prevention into reproductive health services will likely require investments in systems, such as human resources and PrEP and HIV testing commodities, to create stable availability and ensure consistent access. Funding: PrEDIRA 2 was supported by funding from Children's Investment Fund Foundation (R-2001-04433). Ms. Zia was funded by the NIH Ruth L. Kirchstein pre-doctoral award (5F31HD105494-02) and Dr. Heffron was funded by National Institute of Mental Health (K24MH123371).http://www.sciencedirect.com/science/article/pii/S258953702300593XAbortionHIV preventionAdolescent girls and young womenStructural factorsHealth systems |
| spellingShingle | Yasaman Zia Lydia Etyang Bernard Nyerere Cyprian Nyamwaro Felix Mogaka Margaret Mwangi Lavender June Roy Njiru Job Mokoyo Susan Kimani Katherine K. Thomas Kenneth Ngure Inviolata Wanyama Elizabeth Bukusi Nelly Mugo Renee Heffron Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context EClinicalMedicine Abortion HIV prevention Adolescent girls and young women Structural factors Health systems |
| title | Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context |
| title_full | Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context |
| title_fullStr | Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context |
| title_full_unstemmed | Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context |
| title_short | Structural influences on delivery and use of oral HIV PrEP among adolescent girls and young women seeking post abortion care in KenyaResearch in context |
| title_sort | structural influences on delivery and use of oral hiv prep among adolescent girls and young women seeking post abortion care in kenyaresearch in context |
| topic | Abortion HIV prevention Adolescent girls and young women Structural factors Health systems |
| url | http://www.sciencedirect.com/science/article/pii/S258953702300593X |
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