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Title
Barriers and facilitators to pre-exposure prophylaxis uptake and continuation: a qualitative study of high-risk adolescent girls and young women 15-24 years in clubs in two districts of Malawi
Presenter
Maria Mkandawire
Authors
M. Mkandawire1, L. Muyumbu2, Y. Nyondo3, B. Maket4, P. Gwaza4, J. Arney5, K. Chawinga6, R. Kundecha7
Institutions
1FHI 360, HIV Programs, Zomba, Malawi, 2FHI 360, East and Southern Africa Office (ESARO), Monitoring and Evaluation, Nairobi, Kenya, 3FHI 360 , Malawi EMPOWER Project, Monitoring and Evaluation, Zomba, Malawi, 4FHI 360, Malawi EMPOWER Project, HIV Programs, Zomba, Malawi, 5FHI 360, Technical Advisor HIV Programs, Washington DC, United States, 6Pakachere Institute for Health and Development, HIV Programs, Zomba, Malawi, 7Christian Health Association of Malawi, HIV Programs, Zomba, Malawi

BACKGROUND: Pre-exposure prophylaxis (PrEP) was approved by the Ministry of Health in October 2020. Expanding Malawi HIV/AIDS Prevention with Local Organizations Working for an effective Epidemic Response (EMPOWER) project-initiated PrEP in Determined, Resilient, Empowered, AIDS-free Mentored and Safe (DREAMS) clubs in March 2021. PrEP uptake among adolescent girls and young women (AGYW) was low, yet the causes were not well understood. We conducted a qualitative study to explore barriers and facilitators to PrEP uptake and continuation among AGYW to inform the development of improvement strategies.
METHODS: We conducted 12 focus group discussions (FGDs) in Zomba (n:6) and Machinga (n:6) districts in October 2021 involving (n:70) AGYW aged 15-24 newly initiated on PrEP, (n:36) screened eligible but declined PrEP and reviewed PrEP trackers for non-continuing users. Follow up FGDs in December 2021 targeted (n:60) continuing and (n:15) non-continuing AGYW. We transcribed FGDs, examined data, did a thematic analysis and interpreted the themes into context.

RESULTS: Barriers to PrEP uptake were low HIV risk perception, lack of comprehensive knowledge, and stigma. Long distances to PrEP sites was a barrier to continuation. Facilitators were high HIV risk perception, peer/community influence, service providers’ attitudes and integration of PrEP in sexual and reproductive health (SRH) services. In January 2022, we integrated PrEP into club sessions; conducted dialogue sessions targeting traditional/religious leaders, parents and caregivers of AGYW to destigmatize PrEP; identified PrEP champions; initiated community-based refills and a PrEP tracker to facilitate targeted counseling and mobilization. This resulted in a 263% and 748% increase in PrEP uptake and continuation respectively from January to September 2022.
CONCLUSIONS: Understanding barriers and facilitators from AGYW perspectives, integrating HIV/SRH services, addressing community misconceptions and stigma, engaging peers/community influencers as change agents are key facilitators and critical in improving PrEP uptake among AGYW.

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