Abstract
IntroductionAs a user‐controlled HIV prevention method, oral pre‐exposure prophylaxis (PrEP) holds particular promise for adolescent girls and young women (AGYW). HIV prevention cascades, critical frameworks for the design and evaluation of PrEP programmes, outline the priorities of identifying individuals at greatest HIV risk and motivating them to initiate PrEP through perceived HIV risk. To inform future iterations of these cascades and PrEP delivery for AGYW, the objective of this study was to understand the level of interest in PrEP among AGYW at highest HIV risk, and the potential role of perceived risk in motivating PrEP interest.MethodsUsing data from a cohort study of HIV‐negative AGYW in Lilongwe, Malawi (February 2016 to August 2017), we assessed the relationship between epidemiologic HIV risk (risk index developed in a previous analysis) and PrEP interest, and the extent to which perceived risk explains the relationship between HIV risk and PrEP interest. We further aimed to operationalize the pre‐initiation steps of the HIV prevention cascade in the study population.ResultsIn total, 825 AGYW were included in analyses, of which 43% met the criterion for high epidemiologic HIV risk. While epidemiologic risk scores were positively associated with PrEP interest, high numbers of AGYW both above and below the high‐risk cutoff were very interested in PrEP (68% vs. 63%). Perceived risk partially explained the relationship between HIV risk and PrEP interest; greater epidemiologic HIV risk was associated with high perceived risk, which was in turn associated with PrEP interest. Many more high‐risk AGYW were interested in PrEP (68%) than expressed a high level of perceived HIV risk (26%).ConclusionsThese results highlight key relationships between epidemiologic HIV risk, risk perception and interest in PrEP. While risk perception did partially explain the relationship between epidemiologic risk and PrEP interest, there may be other important motivational mechanisms that are not captured in many HIV prevention cascades. The high number of participants with risk scores below the high‐risk cutoff who both expressed high perceived risk and interest in PrEP suggests that demand for PrEP among AGYW may not be well aligned with epidemiologic risk.
Highlights
As a user-controlled HIV prevention method, oral pre-exposure prophylaxis (PrEP) holds particular promise for adolescent girls and young women (AGYW)
Understanding whether or not this mechanism is evident in AGYW can inform whether risk perception is an important target in programmes to promote PrEP interest and eventual uptake among high-risk young women, and can be used to inform future iterations of the HIV prevention cascade to clarify priorities for motivational mechanisms to target. To address this gap, using data from an observational cohort study with AGYW in Lilongwe, Malawi we aim to answer two primary questions: (1) Are those AGYW at highest HIV risk the most likely to (a) perceive themselves to be at risk and (b) express interest in PrEP use? and (2) To what extent does perceived risk explain the relationship between HIV risk and PrEP interest? We further aim to operationalize the pre-initiation stages of the prevention cascade in the study population
AGYW reporting high perceived risk had over twice the odds of being very interested in PrEP as those reporting lower perceived risk
Summary
As a user-controlled HIV prevention method, oral pre-exposure prophylaxis (PrEP) holds particular promise for adolescent girls and young women (AGYW). While risk perception did partially explain the relationship between epidemiologic risk and PrEP interest, there may be other important motivational mechanisms that are not captured in many HIV prevention cascades. In Malawi, AGYW ages 15 to 24 have more than twice the risk of HIV infection as their male counterparts [3,4,5] This disproportionate burden of HIV risk among AGYW can be explained by a number of biological, social and behavioural factors [6], including difficulty negotiating condom use [7,8]. We need to understand how AGYW at greatest risk may become motivated to consider PrEP
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