PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa
Abstract Introduction HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre‐exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice ca...
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2025-07-01
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| Online Access: | https://doi.org/10.1002/jia2.26457 |
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| author | Virginia A. Fonner Elizabeth Irungu Mark Conlon Carolyne A. Akello Emily Gwavava Kevin K'Orimba Nicolette P. Naidoo Patriciah Jeckonia Imelda Mahaka Saiqa Mullick Mamatli Chabela Roisin Drysdale Jacqueline Kabongo Millicent Kiruki Ivan Segawa Munyaradzi Dobbie Nthuseng Marake Peter Mudiope Hasina Subedar Rose Wafula Andrew Kazibwe Jason Reed Katharine Kripke Douglas Taylor Mu‐Tien Lee Glory Chidumwa Adatia Chivafa Ramatsoai Soothoane Margaret Eichleay Ashley Mayo Courtney McGuire Tara McClure Tatenda Yemeke Kristine Torjesen the CATALYST study team |
| author_facet | Virginia A. Fonner Elizabeth Irungu Mark Conlon Carolyne A. Akello Emily Gwavava Kevin K'Orimba Nicolette P. Naidoo Patriciah Jeckonia Imelda Mahaka Saiqa Mullick Mamatli Chabela Roisin Drysdale Jacqueline Kabongo Millicent Kiruki Ivan Segawa Munyaradzi Dobbie Nthuseng Marake Peter Mudiope Hasina Subedar Rose Wafula Andrew Kazibwe Jason Reed Katharine Kripke Douglas Taylor Mu‐Tien Lee Glory Chidumwa Adatia Chivafa Ramatsoai Soothoane Margaret Eichleay Ashley Mayo Courtney McGuire Tara McClure Tatenda Yemeke Kristine Torjesen the CATALYST study team |
| author_sort | Virginia A. Fonner |
| collection | DOAJ |
| description | Abstract Introduction HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre‐exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa. Methods The CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis. Results Of 3967 participants, 44.9% were AGYW (15−24 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants ≤ 24 years (p = 0.007) and participants who were pregnant (p = 0.002) or breastfeeding (p < 0.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (p < 0.001). Of participants returning for ≥ 1 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (p < 0.001) and those ≤ 24 years (p < 0.001), PrEP naïve at enrolment (p < 0.001) or not currently using contraception (p = 0.03). Conclusions We demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed. |
| format | Article |
| id | doaj-art-3d26b42e783e4835b0a95c066e11ea4c |
| institution | Matheson Library |
| issn | 1758-2652 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
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| series | Journal of the International AIDS Society |
| spelling | doaj-art-3d26b42e783e4835b0a95c066e11ea4c2025-07-05T10:51:18ZengWileyJournal of the International AIDS Society1758-26522025-07-0128S2n/an/a10.1002/jia2.26457PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan AfricaVirginia A. Fonner0Elizabeth Irungu1Mark Conlon2Carolyne A. Akello3Emily Gwavava4Kevin K'Orimba5Nicolette P. Naidoo6Patriciah Jeckonia7Imelda Mahaka8Saiqa Mullick9Mamatli Chabela10Roisin Drysdale11Jacqueline Kabongo12Millicent Kiruki13Ivan Segawa14Munyaradzi Dobbie15Nthuseng Marake16Peter Mudiope17Hasina Subedar18Rose Wafula19Andrew Kazibwe20Jason Reed21Katharine Kripke22Douglas Taylor23Mu‐Tien Lee24Glory Chidumwa25Adatia Chivafa26Ramatsoai Soothoane27Margaret Eichleay28Ashley Mayo29Courtney McGuire30Tara McClure31Tatenda Yemeke32Kristine Torjesen33the CATALYST study teamFHI 360DurhamNorth CarolinaUSAJhpiego Nairobi KenyaFHI 360DurhamNorth CarolinaUSAFHI 360Kampala UgandaPangaea ZimbabweHarareZimbabweLVCT HealthNairobiKenyaWits RHI, University of the Witwatersrand Johannesburg South AfricaLVCT HealthNairobiKenyaPangaea ZimbabweHarareZimbabweWits RHI, University of the Witwatersrand Johannesburg South AfricaJhpiego Nairobi KenyaWits RHI, University of the Witwatersrand Johannesburg South AfricaPangaea ZimbabweHarareZimbabweLVCT HealthNairobiKenyaFHI 360Kampala UgandaZimbabwe Ministry of HealthHarareZimbabweLesotho Ministry of HealthMaseruLesothoUganda Ministry of HealthKampalaUgandaWits RHI, University of the Witwatersrand Johannesburg South AfricaKenya Ministry of HealthNairobiKenyaTASOKampala UgandaJhpiego, Baltimore Maryland USAAvenir HealthTakoma ParkMarylandUSAFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAWits RHI, University of the Witwatersrand Johannesburg South AfricaPangaea ZimbabweHarareZimbabweJhpiego Nairobi KenyaFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAFHI 360DurhamNorth CarolinaUSAAbstract Introduction HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre‐exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa. Methods The CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis. Results Of 3967 participants, 44.9% were AGYW (15−24 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants ≤ 24 years (p = 0.007) and participants who were pregnant (p = 0.002) or breastfeeding (p < 0.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (p < 0.001). Of participants returning for ≥ 1 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (p < 0.001) and those ≤ 24 years (p < 0.001), PrEP naïve at enrolment (p < 0.001) or not currently using contraception (p = 0.03). Conclusions We demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed.https://doi.org/10.1002/jia2.26457femaleKenyaLesothopre‐exposure prophylaxisSouth AfricaUganda |
| spellingShingle | Virginia A. Fonner Elizabeth Irungu Mark Conlon Carolyne A. Akello Emily Gwavava Kevin K'Orimba Nicolette P. Naidoo Patriciah Jeckonia Imelda Mahaka Saiqa Mullick Mamatli Chabela Roisin Drysdale Jacqueline Kabongo Millicent Kiruki Ivan Segawa Munyaradzi Dobbie Nthuseng Marake Peter Mudiope Hasina Subedar Rose Wafula Andrew Kazibwe Jason Reed Katharine Kripke Douglas Taylor Mu‐Tien Lee Glory Chidumwa Adatia Chivafa Ramatsoai Soothoane Margaret Eichleay Ashley Mayo Courtney McGuire Tara McClure Tatenda Yemeke Kristine Torjesen the CATALYST study team PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa Journal of the International AIDS Society female Kenya Lesotho pre‐exposure prophylaxis South Africa Uganda |
| title | PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa |
| title_full | PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa |
| title_fullStr | PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa |
| title_full_unstemmed | PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa |
| title_short | PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub‐Saharan Africa |
| title_sort | prep choice in the real world results of a prospective cohort study describing uptake and use patterns of oral prep and the dapivirine vaginal ring among women in sub saharan africa |
| topic | female Kenya Lesotho pre‐exposure prophylaxis South Africa Uganda |
| url | https://doi.org/10.1002/jia2.26457 |
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