Uptake of Contraception Among Adolescent Girls and Young Women PrEP Clients: Leveraging the Opportunity to Strengthen HIV and Sexual and Reproductive Health Integration.

Melanie Pleaner,Vusile Butler,Zukiswa Fipaza,Sydney Ncube,Saiqa Mullick,Khuthala Mabetha,Mags Beksinska,Letitia Greener

doi:10.3389/frph.2021.684114

Melanie Pleaner, Vusile Butler + Show 6 more

Open Access

https://doi.org/10.3389/frph.2021.684114

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Abstract

The introduction of oral pre-exposure prophylaxis (PrEP) for HIV prevention was a major breakthrough in South Africa (SA). While the initial introduction focused on issues such as the development and implementation of new guidelines, supply, and the development of demand creation strategies, the need to integrate PrEP services with sexual and reproductive health (SRH) services has gained traction both globally and locally. Project PrEP was implemented in eight healthcare facilities and four mobile clinics in three provinces in SA. Using monitoring data from across the four project clusters, and 4,949 clients, over a 21-month period, we conducted an analysis of baseline routine monitoring data to examine contraceptive uptake in adolescent girls and young women (AGYW) initiating PrEP at project sites. Two-thirds of women (62.3%, n = 3,083) reported the current use of contraception at baseline, with the most commonly used methods being hormonal injectables (61.9%, n = 1,829) and male condoms (19.4%, n = 575). A third (32.3%, n = 603) of the non-contraceptive users accepted a method at PrEP initiation. From a total of 1,007 (32.7%) current contraceptive users at baseline, 865 (85.9%) chose the same or a different method at this visit. The method uptake at PrEP initiation increased the overall contraceptive prevalence by 12.2 to 74.5%. Data indicated that over a third (38.8%, n = 725) who were not using a method at baseline described themselves as consistent condom users. Although a major focus of the project was on PrEP service provision, all women were counseled and offered contraceptive services. The acceptance of a method by a third of non-users was promising; however, more understanding of those who did not take up a method is required. The need to leverage opportunities for the promotion of the integration of HIV and family planning at all levels of PrEP provision was highlighted.

Highlights

South Africa (SA) has the largest HIV epidemic in the world
We looked at those AGYW, who were HIV-negative, and were offered and accepted oral pre-exposure prophylaxis (PrEP) at the 12 project sites during this period (n = 4, 949)
The method mix among AGYW aged 15–24 years using contraception mirrored that seen in the SADHS with the injectables being the most common method used at baseline and accepted by the new users, and male condoms the second most utilized method

Summary

Introduction

South Africa (SA) has the largest HIV epidemic in the world. In 2019, there were 7.5 million people living with HIV and 200,000 new infections [1]. Oral pre-exposure prophylaxis (PrEP), comprising the antiretrovirals emtricitabine and tenofovir disoproxil fumarate (TDF), has been a game changer in HIV prevention, with over 90% prevention of HIV when used correctly [3, 4]. Oral pre-exposure prophylaxis was initially introduced into SA via several research and demonstration projects, focusing initially on key populations, including men who have sex with men, sex workers, and AGYW [5, 6]. The launch of the SA national PrEP guidelines in 2016 [7] was combined with a nationally coordinated training and implementation program, and access to PrEP expanded in a phased approach to include a range of target populations and public sector health facilities, educational institutions, and non-governmental organizations [8]. There was growing recognition of the need to leverage opportunities to combine HIV services with complementary sexual and reproductive health (SRH) services, with contraception forming an important component of this service delivery package [9,10,11]

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