Breaking Barriers: How Practitioners Can Enhance PrEP Uptake and Adherence Among Young Women
In the realm of HIV prevention, particularly among adolescent girls and young women (AGYW) in sub-Saharan Africa, the challenge of increasing pre-exposure prophylaxis (PrEP) uptake and adherence is significant. The recent study titled "Breaking down relationship barriers to increase PrEP uptake and adherence among adolescent girls and young women in Kenya" offers a promising intervention model that practitioners can learn from and implement in their contexts.
The Study: A Closer Look
The study, conducted in Siaya County, Kenya, involved a multi-level, community-based intervention known as Tu'Washindi. This intervention aimed to address relationship and violence-related barriers that hinder PrEP use among AGYW. It was piloted in a cluster-randomized controlled trial, involving 103 participants aged 17-24, who were either eligible for or already taking PrEP.
The intervention comprised three components:
- Empowerment-Based Support Club: An eight-session club designed to empower AGYW through biweekly and monthly meetings.
- Community Sensitization: Targeted events aimed at educating male partners about PrEP, led by male "Change Agents."
- Couples’ PrEP Education Event: "Buddy Days" where AGYW and their partners attended educational sessions together.
The results were promising, showing that participants in the intervention arm were more likely to initiate PrEP and had better adherence compared to the control group. Notably, there was no increase in intimate partner violence (IPV) as a result of the intervention.
Practical Implications for Practitioners
For practitioners working in similar contexts, the Tu'Washindi intervention provides a valuable framework. Here are some key takeaways:
- Community Engagement: Engaging both AGYW and their male partners is crucial. The study showed that involving male partners through education and sensitization can reduce resistance and increase support for PrEP use.
- Empowerment and Education: Empowering AGYW through support clubs and education can enhance their self-efficacy and adherence to PrEP.
- Multi-Level Approach: Addressing barriers at multiple levels—individual, partner, and community—can lead to more effective outcomes.
- Monitoring and Evaluation: Using tools like Wisepill electronic monitoring devices can help track adherence and identify areas for improvement.
Encouraging Further Research
While the Tu'Washindi intervention shows promise, further research is needed to explore its long-term effectiveness and scalability. Practitioners are encouraged to collaborate with researchers to adapt and test similar interventions in different settings, considering local cultural and social dynamics.
Moreover, exploring additional strategies to address stigma, enhance risk perception, and manage side effects could further improve adherence rates. Incorporating new PrEP delivery modalities, such as injectables or rings, may also reduce the burden on users.
Conclusion
The Tu'Washindi intervention highlights the importance of a holistic, community-based approach to increasing PrEP uptake and adherence among AGYW. By implementing these strategies, practitioners can play a pivotal role in reducing HIV incidence and empowering young women in high-risk regions.
To read the original research paper, please follow this link: Breaking down relationship barriers to increase PrEP uptake and adherence among adolescent girls and young women in Kenya: safety and preliminary effectiveness results from a pilot cluster-randomized trial.
