Adherence and associated factors with HIV oral Pre-exposure Prophylaxis among high-risk adolescent girls and young women aged (15-24 years) at Luwero Hospital in Luwero District, Uganda

Abstract

Introduction Globally, human immunodeficiency virus (HIV)remains a significant global health problem with an estimated 38.4 million people seen to have been infected with HIV in 2021. Evidence has also shown that pre-exposure prophylaxis (PrEP) is a bio-medical intervention that can effectively reduce the incidence of HIV by 25%. With the HIV prevalence among high-risk adolescent girls and young women dramatically increasing in Uganda and the rest of the world, the World Health Organization (WHO) recommends pre-exposure prophylaxis (PrEP) among young women, especially the ones who are sexually active and at high-risk of acquiring HIV. Luwero district registered a high prevalence of PrEP initiations among high-risk adolescent girls and young women in 2021/2022 however, the adherence level remains low. There is limited information about adherence to PrEP among high-risk AGYW in the Luwero District. Therefore, this study aims to understand the determinants of adherence to PrEP among high-risk AGYW at Luwero hospital in Luwero District. Objective To determine the level of adherence to oral PrEP for HIV and associated factors among high-risk adolescent girls and young women 15-24 years at Luwero hospital in Luwero District. Methods This was a cross-sectional study conducted at Luwero Hospital between September and October 2023. Both quantitative and qualitative methods of data collection were used among 123 sexually active high-risk AGYW, five in-depth interviewees and five key informants. The quantitative methods employed simple random sampling for participant selection, while the qualitative methods used purposive sampling for insightful perspectives. A standardized questionnaire was used for the collection of quantitative data which was then cleaned and analyzed using STATA.15 software. Modified Poisson regression was used to obtain prevalence ratios as a measure of association where statistical significance of p<0.05 was used for statistical inference. Qualitative data were obtained from verbatim transcriptions of in-depth interviews (IDIs) and key informant interviews (KIIs) and analyzed thematically using Atlas.ti version 9. Thematic analysis was used to come up with emerging themes relevant to answering adherence to PrEP for HIV. Some of the reported statements were quoted verbatim to give exact meaning. Results The level of adherence to HIV oral PrEP among high-risk adolescent girls and young women was at 24%. The factors associated with adherence to PrEP were; living 2 km to 5kms (aPR=0.44,95% CI:0.22-0.86), and more than 5kms from the health facility (aPR=0.43, 95% CI:0.21-0.86), follow up calls from health workers (aPR=1.36, 95% CI:1.15-1.86), perceived awareness of risk of HIV infection in the presence of PrEP (aPR=11.35, 95% CI: 2.82-45.67). From KIIs and IDIs the factors commonly highlighted by high-risk adolescent girls and young women as facilitators to adherence to PrEP are perceived awareness of risk of HIV infection, health worker attitude towards patients, knowledge about PrEP, follow-up calls, and integration of PrEP with other family planning services. Barriers included attitude towards PrEP and distance to the health facility. Conclusion and Recommendation The study demonstrated that adherence to oral HIV PrEP among high-risk adolescent girls and young women 15-24 years was relatively low in the study area. The most important factors associated with adherence to PrEP are the perceived awareness of risk of HIV infection in the presence of PrEP, health worker attitude toward patients, knowledge about PrEP, follow-up calls from health workers, and integration of PrEP services with family planning services. Based on the results, policymakers need to expand follow up call programs for all users to inform AGYW about HIV risk and the benefits of PrEP when taken with maximum adherence. This can be done through educational programs like community-based education sessions and workshops. Also, the Ministry of health and development partners should consider operationalizing mobile health units to ease accessibility, especially in rural areas.