Factors associated with awareness and acceptability of pre-exposure prophylaxis among women of reproductive age in Kenya: an analysis of the 2022 Kenya demographic and health survey
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Background
Human Immunodeficiency Virus (HIV) remains a significant public health challenge in Kenya, with women of reproductive age (WRA) at an increased risk. Although pre-exposure prophylaxis (PrEP) was integrated into Kenya’s HIV prevention program close to a decade ago, it is still underutilized among WRA outside the key populations at a high risk for HIV. Understanding PrEP awareness and acceptability is crucial for scaling prevention efforts. This study, therefore aimed to determine the factors associated with PrEP awareness and acceptability among WRA using the 2022 Kenya Demographic and Health Survey (KDHS).
Methods
Secondary data comprising 16,638 WRA from the 2022 KDHS, which used a two-stage stratified sampling design was analyzed using univariable and multivariable logistic regression models in SPSS (version 29).
Results
48.4% (95% CI: 47.2–49.7) of WRA were aware of PrEP, and 75.0% (95% CI: 73.3–76.6) approved its use. Higher education (tertiary: Adjusted odds ratio (AOR): 2.11, 95% CI: 1.50–2.97), good HIV knowledge (AOR 2.70, 95% CI: 1.67–4.36), living with HIV (AOR 3.79, 95% CI: 1.59–9.03) and multiple sexual partners (AOR 2.29, 95% CI: 1.44–3.64) were associated with high odds of PrEP awareness compared with their counterparts. Women from Nyanza (AOR 2.61, 95% CI: 1.61–4.22) and Northeastern regions, and those from the Luo tribe (AOR 2.51, 95% CI: 1.57–4.02), also had high odds of awareness than those from the Coastal region and Kikuyu tribe, respectively. Muslim women (AOR 0.51, 95% CI: 0.31–0.84) and those who justified wife-beating (AOR 0.63, 95% CI: 0.51–0.76) were less likely to be aware of PrEP. Compared with their counterparts, we found high odds of PrEP acceptability among women who had their first sexual intercourse at ≥25 years (AOR 40.06, 95% CI: 14.59–109.99), had good HIV knowledge (AOR 4.88, 95% CI: 1.28–18.62) and lived in Nyanza province (AOR 8.76, 95% CI: 3.27–23.46).
Conclusion
We found a low PrEP awareness level among WRA when compared with its acceptability. Sociodemographic, behavioral, and psychosocial factors seem to influence PrEP awareness and acceptability. Targeted interventions, including integrating PrEP education in healthcare, school sexuality curriculum, workplaces, regional and culturally specific mass media campaigns, and addressing socio-cultural barriers, are vital to enhance uptake and reduce HIV incidence.
