Willingness of adolescent girls and young women to use long acting injectable prep for HIV prevention in Uganda: A case study of Kampala

Abstract

Pre-exposure prophylaxis (PrEP) has proven to be a powerful tool in preventing HIV infection, and available evidence suggests that when taken as prescribed, the risk of infection could be reduced especially among those who are at high risk of HIV infection. Although PrEP is increasingly being recognised in the fight against HIV infection, there is limited information about the factors associated with willingness to use different PrEP modalities among adolescent girls and young women (AGYW) in Uganda. This study aims at assessing the factors which influence the willingness to use long-acting HIV prevention Injectable PrEP (LAI-PrEP) among high-risk AGYW (14-24years) in Kampala. We used secondary data from a cohort study conducted in 2019 entitled, “Interventions for HIV Prevention among Adolescents and Young Women (IPAD)”. Data was sourced from 285 adolescents and young women aged between 14-24 who often reported transactional sex and were at a higher risk of contracting HIV. We used frequency distributions for description, chi-square tests for initial associations, and multivariable complementary log-log regression to examine the underlying factors that influence willingness to use injectable PrEP among at risk AGYW. The results revealed that 69.8% of participants showed willingness to use LAI PrEP despite 3.9% having knowledge about LAI PrEP before enrolment. Participants that were divorced/separated (OR=1.74, p=0.039) and those with multiple sexual partners (OR=2.12, p=0.000) were more likely to be willing to use LAI-PrEP while those that were screened as heavy episodic drinkers (consuming 6 or more drinks on an occasion as per the AUDIT tool) were less likely to be willing to use LAI-PrEP (OR=0.61, p=0.012). These results highlight three factors which influence the willingness to use LAI-PrEP including marital status, heavy episodic drinking, and multiple sexual partners. High willingness to use LAI PrEP despite low awareness of LAI PrEP among AGYW at baseline. The study recommends PrEP education and counseling to increase awareness of LAI PrEP as an alternative HIV prevention method for AGYW at risk of HIV infection. Given the alterations of cognitive function and memory while under the influence of alcohol, education messages should also focus on heavy episodic drinkers to enable them to effectively use long-acting HIV prevention methods like LAI PrEP which do not require frequent dosing. LAI PrEP has shown efficacy in the HPTN 084 trial; the product is approved for use by the Government of Uganda (MoH) and should be expedited for use by AGYW engaged in paid sex and multiple sexual partnerships.