A decision support tool has similar high PrEP uptake and increases early PrEP persistence in adolescent girls and young women in South Africa: results from a randomized controlled trial.

Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE

Publication: 2017- : Hoboken, NJ : John Wiley & Sons, Inc
Original Publication: [London] : BioMed Central

HIV Infections*/ethnology ; HIV Infections*/prevention & control ; Pre-Exposure Prophylaxis* ; Health Literacy* ; Decision Support Systems, Clinical* ; Patient Participation*; Adolescent ; Adult ; Female ; Humans ; Young Adult ; Ambulatory Care Facilities ; Black People ; South Africa ; Southern African People ; Decision Making

Introduction: African adolescent girls and young women (AGYW) have high rates of HIV acquisition and are a priority population for HIV pre-exposure prophylaxis (PrEP). PrEP implementation has been limited by AGYW's low perceived HIV risk and provider demands. A decision support tool (DST) with information about PrEP could improve clients' risk perception, knowledge about PrEP, informed decision-making and motivation to use PrEP based on their risk, facilitating PrEP delivery in primary healthcare (PHC) clinics.
Methods: We designed MyPrEP, a client-facing DST about PrEP and HIV prevention, with youth-friendly information and images. The impact of the MyPrEP tool was assessed among HIV-negative women aged 18-25 years presenting to a PHC clinic in Johannesburg, South Africa from March 2019 to 2020. AGYW were randomized by day to the DST or a general health website as the control condition. A clinician blinded to DST versus control allocation provided standard of care counselling about PrEP, offered PrEP, administered a questionnaire and conducted sexually transmitted infection testing. The primary outcome was PrEP initiation and the secondary outcome was PrEP persistence at 1 month, determined by pharmacy dispensation records.
Results: Of 386 AGYW screened, 353 were randomized (DST n = 172, control n = 181) with a median age of 21 years (interquartile range [IQR] 20, 23) and 56% (199/353) attending the clinic for HIV testing, 46% (164/353) using contraception, 15% (53/353) using condoms consistently and 37% (108/353) with a curable sexually transmitted infection. PrEP was initiated by 97% in the DST group and 94% in the control group (OR 1.79; 95% confidence interval, CI = 0.79-1.53), of whom two-thirds planned to continue PrEP until they decided if they liked PrEP. At 1 month, PrEP persistence was 19% in the DST and 10% in the control group (OR 1.97, 95% CI 1.08-3.69). Ninety-nine percent randomized to the DST reported satisfaction with MyPrEP.
Conclusions: Among AGYW attending a South African PHC clinic, PrEP uptake was >90% with two-fold higher PrEP persistence at 1 month in those randomized to use the MyPrEP DST. Given the need for strategies to support PrEP implementation and improve low PrEP persistence among African AGYW, a PrEP DST warrants further evaluation.
(© 2023 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

Patient Educ Couns. 2020 Feb;103(2):315-320. (PMID: 31537316)
N Engl J Med. 2015 Feb 5;372(6):509-18. (PMID: 25651245)
N Engl J Med. 2012 Aug 2;367(5):411-22. (PMID: 22784040)
Patient Educ Couns. 2020 Feb;103(2):254-265. (PMID: 31493959)
AIDS. 2020 Oct 1;34(12):1801-1811. (PMID: 32558660)
J Acquir Immune Defic Syndr. 2016 Jul 1;72(3):333-43. (PMID: 26918545)
Lancet HIV. 2022 Oct;9(10):e680-e689. (PMID: 36087612)
Med Decis Making. 2019 May;39(4):301-314. (PMID: 31142194)
J Acquir Immune Defic Syndr. 2014 Dec 15;67(5):555-63. (PMID: 25393942)
Am J Obstet Gynecol. 2019 Jun;220(6):565.e1-565.e12. (PMID: 30763545)
Lancet HIV. 2022 Apr;9(4):e254-e268. (PMID: 35364026)
J Int AIDS Soc. 2022 Jul;25(7):e25962. (PMID: 35822945)
JAMA Pediatr. 2017 Nov 1;171(11):1063-1071. (PMID: 28873128)
AIDS Behav. 2018 Nov;22(11):3468-3479. (PMID: 29404757)
J Int AIDS Soc. 2019 Jul;22 Suppl 4:e25298. (PMID: 31328444)
Contraception. 2019 Nov;100(5):420-423. (PMID: 31404538)
Cochrane Database Syst Rev. 2014 Jan 28;(1):CD001431. (PMID: 24470076)

R01 MH114544 United States MH NIMH NIH HHS; R01MH114544 United States NH NIH HHS

Keywords: HIV prevention; South Africa; choice; decision support tool; pre-exposure prophylaxis; women

Date Created: 20230827 Date Completed: 20230916 Latest Revision: 20231003

20231003

PMC10460672

10.1002/jia2.26154

37634942