Expanding the reach of HIV pre-exposure prophylaxis (PrEP) among Kenyan adolescent girls and young women: the acceptability of HIV PrEP integration into post-abortal care services

• Published in: AIDS care 2025-02, Vol.37 (2), p.233-243
• Main Authors: Casmir, Edinah, Wairimu, Njeri, Etyang, Lydia, Mogaka, Felix, Oware, Kelvin, Nyerere, Bernard, Nafula, Inviolata, Kimani, Susan, Bukusi, Elizabeth, Heffron, Renee, Mugo, Nelly, Ngure, Kenneth
• Format: Article
• Language: English
• Subjects: Acceptability; Adolescent; Adolescent girls; adolescent girls and young women; Adolescents; Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Clinics; Cross-Sectional Studies; differentiated delivery; Feasibility; Feasibility studies; Female; Focus Groups; Gender equality; Girls; Good health and well-being; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Integrated care; Integration; Interviews; Kenya; Partnerships for the goals; Patient Acceptance of Health Care - statistics & numerical data; Pre-Exposure Prophylaxis - methods; Pregnancy; PrEP integration into PAC; Prevention programs; Preventive medicine; Prophylaxis; Psychological safety; Qualitative analysis; Qualitative Research; qualitative study; Reduced inequalities; Staffing; Stigma; Uptake; Young Adult; Young women
• ISSN: 0954-0121; 1360-0451; 1360-0451
• DOI: 10.1080/09540121.2024.2443678

Adolescent girls and young women (AGYW) seeking post-abortal care (PAC) remain at risk of unintended pregnancies and HIV due to infrequent condom use. Integrating HIV prevention services, such as PrEP, into PAC services offers an opportunity to enhance reach, uptake, and efficiency, particularly in high-burden settings like Kenya. However, data on acceptability, feasibility, and sustainability of PAC clinics as entry points for PrEP is limited. A cross-sectional qualitative study, part of a cluster-randomized trial in 14 Kenyan public and private facilities, explored the integration of PrEP delivery for AGYW aged 15-30 within PAC clinics. Using in-depth interviews, focus group discussions, and key informant interviews, the study gathered perspectives from AGYW, providers, and implementing partners. Guided by the theoretical framework of acceptability, findings revealed receptiveness for the integration as a timely and effective intervention to expand PrEP reach, enhance access , and reduce stigma. Provider competence, their attitudes towards the integration, and AGYWs' confidence in using PrEP were identified as critical influencers. Essentail operational considerations were staffing, availability of safe spaces, commodity management, and efficient reporting systems. The study highlights the acceptability and scalability of integrating PrEP services into PAC while emphasizing the need for strategies to enhance operational efficiency.