Fostering access to PrEP among high-risk adolescent girls and young women aged 16 to 24 years through the DREAMS initiative in 4 districts in Zambia
BACKGROUND: In Zambia, adolescent girls and young women (AGYW) remain at high risk of HIV infection due to social, cultural, and economic vulnerabilities. Pre-exposure prophylaxis (PrEP) is effective at preventing HIV especially when used as part of a combination prevention approach. However, limited data exists on PrEP eligibility, uptake and persistence among AGYW in sub-Saharan Africa.The University of Maryland Baltimore CIRKUITS and Z-CHECK projects implemented the Determined Resilient Empowered AIDS-free Mentored Safe (DREAMS) initiative aimed at educating young girls, communities and families on HIV prevention using evidence-based interventions, as a holistic HIV prevention intervention, including PrEP provision to AGYW.
METHODS: We examined PrEP uptake among AGYW aged 16 to 24 years using a retrospective cohort enrolled in DREAMS between October 2020 and September 2021 in four districts of Zambia. AGYW were screened for substantial HIV risk; those eligible were consented and voluntarily initiated on PrEP at DREAMS centers by health care workers. Follow ups were conducted for refills and laboratory investigations. Multivariable logistic regression was used to examine variables associated with obtaining at least one PrEP refill following initiation.
RESULTS: A total of 1,734 AGYW were assessed for PrEP eligibility, of whom 1,733 (99.9%) were eligible and 1,716 (99.0%) started PrEP. The median age at PrEP initiation was 21 years (IQR: 19, 23). Of those who started, 938 (54.7%) had at least one PrEP refill. Factors associated with obtaining at least one refill included age 20-24 years (aOR 1.88, 95% CI 1.51-2.34), being married (aOR 1.80, 95% CI 1.37-2.36) or sexually active in last six months (aOR 2.82, 95% CI 2.29-3.48), and reporting an STI in the prior six months (aOR 10.13, 95% CI 3.08-33.34). Among AGYW who discontinued PrEP and had at least one follow-up visit (99, 10.0%), reasons for discontinuation included: no longer at risk (56, 57%), relocation (12, 12%), and side effects (7, 7%).
CONCLUSIONS: The DREAMS initiative was successful at reaching AGYW with PrEP services. A high proportion at risk of HIV elected to initiate PrEP for at least some time. More evidence is needed to assess reasons for discontinuation and improve persistence for those with sustained risk.
J. Chipukuma * (1), P. Olowski (1), B. Lindsay (1,2), L. Mwango (3), K. Tembo (1), C. Bwale (3), P. Makasa (3), M. Muchoka (3), S. Tembo (3), W. Mbokile (3), B. Bwembelo (3), E. Fundulu (3), C. Munsongo (4), K. Watala (4), B. Musonda (4), J. Okuku (5), A. Mwila (5), C. Muleya (5), C.W. Claassen (1,2)
(1) Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia, (2) Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, United States, (3) Ciheb Zambia, Lusaka, Zambia, (4) Ministry of Health, Zambia, Lusaka, Zambia, (5) U.S. Center for Disease Control and Prevention, Lusaka, Lusaka, Zambia