Self-discontinuation of Pre-Exposure Prophylaxis Among Adolescent Girls and Young Women in Mazowe District, Zimbabwe
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Background
Adolescent girls and young women (AGYW) in Zimbabwe are at high risk of acquiring HIV. In 2020, HIV incidence among AGYW was 9.5 times that of males. AGYW are targeted for Pre-Exposure Prophylaxis (PrEP). In Mazowe District, 28.7% of AGYW who were initiated on PrEP in 2021 self-discontinued within a month. This limits the effectiveness of PrEP and increases the risk of HIV drug resistance. We determined factors associated with PrEP self-discontinuation among AGYW in Mazowe.
Methods
We conducted an analytical cross-sectional study among HIV-negative AGYW initiated on PrEP. Participants were randomly selected proportionate to number initiated on PrEP in 20 health facilities in Mazowe District. Using Interviewer-administered questionnaires, data was collected on sexual behaviour, reasons for starting PrEP, and determinants of self-discontinuation. We performed logistic regression analysis at 5% significance-level to determine independent factors for PrEP self-discontinuation using Epi Info 7.2.
Results
Of the 384 AGYW included in the study, 57.8% were married, 24.5% were divorced, and 17.7% were never married. Commonly reported reasons for starting PrEP were multiple sexual partners (29.2%) and promiscuous sexual partners (29.2%). The proportion of PrEP self-discontinuation was 41% with a median time to self-discontinuation of 4 (IQR 2-5) months. Of 157 AGYW who self-discontinued PrEP, 59.2% had multiple sexual partners, and 57.3% had transactional sex after discontinuing PrEP. Independent factors associated with PrEP self-discontinuation among AGYW were being a sex worker [aOR 4.86; 95% CI (1.33-17.69)], non-disclosure of PrEP status to sexual partner [aOR 3.63; 95% CI (2.13-6.19)], being discouraged to take PrEP by sexual partner [aOR 3.04; 95% CI (1.31-7.04)] and experiencing PrEP side effects [aOR 2.38; 95% CI (1.49-3.81)].
Conclusions
Being a sex worker, lack of partner support, and PrEP side effects were significant risk factors for self-discontinuation of PrEP. Improved, differentiated PrEP services’ provision and investing in community awareness may enhance PrEP retention.
