Pre-exposure prophylaxis non-adherence and associated factors among young key populations receiving HIV services at MARPI and Taso Clinics in Kampala,Uganda

Abstract

Background: The rising non-adherence to Pre-Exposure Prophylaxis among young key populations is a growing concern, threatening HIV prevention efforts. PrEP, a crucial tool in the fight against HIV/AIDS, is a medication approved for individuals at risk of HIV transmission. Despite its potential, recent studies have shown a concerning trend of non-adherence among young individuals, putting them at higher risk of HIV infection. This study explored PrEP non-adherence and associated factors among young key populations receiving HIV services at MARPI and TASO clinics in Kampala, Uganda. Methods: A hospital-based cross-sectional study was conducted from February to April 2023, with 287 young key populations aged 15-24 receiving HIV services at MARPI and TASO clinics in Kampala, Uganda. Non-adherence was assessed through self-reported instances of missing daily medication doses at least once. Data was collected using semi-structured questionnaires, and informed consent was required for participation. Data analysis was performed using Stata version 15/MP (STATA CORP, TEXAS, USA), with descriptive statistics and modified Poisson regression for further analysis. Results: In this study, 287 participants were enrolled, but only 270 provided complete information on key study variables. Of these, most were female (61.1%, n=65), aged 20-24 (83.7%, n=226), living in urban areas (92.2%, n=226), single (81.5%, n=220), had completed secondary education (58.5%, n= 158), and were unemployed (70.4%, n= 190). Additionally, 15% (n= 40) were concerned about PrEP's odor or taste, 72% (n=196) feared the pill size, 73.7%( n=199) preferred not to take PrEP in tablet form, and 93%( n=252) reported that PrEP was provided free of charge. Nearly half (44.4%, n=120) reported missing PrEP doses at some point. Non-adherence was associated with employment status [Adj PR: 0.68 (95% CI: 0.52-0.87); p-value= 0.012], fear of parents (Adj PR: 1.66 (95% CI: 1.30-2.12), p-value= <0.001), medicine stock-outs at the health facility (Adj PR: 1.63 (95% CI: 1.19-2.22, p value= 0.002) and rude health workers (Adj PR: 0.6 (95% C.I: 0.38-0.97), p-value= 0.035). Conclusion and Recommendations: The study found a 44.4% PrEP non-adherence rate among young key populations receiving HIV services at MARPI and TASO clinics in Kampala, Uganda. Factors contributing to non-adherence included employment status, fear of parents, medicine stock-outs, and rude health workers. To address these issues, health facilities should ensure a consistent supply of PrEP, create youth-friendly environments by training health workers, sensitize parents about PrEP's importance, and offer additional support to unemployed individuals to overcome adherence barriers. Keywords: PrEP non-adherence, Young Key Populations, Central Uganda, HIV prevention, Quantitative study