BACKGROUND: HIV burden remains high in Zimbabwe. Adolescent girls and young women (AGYW) are disproportionately affected with an HIV incidence of 0.54% compared to 0.13% among their male counterparts (ZIMPHIA, 2020). Whilst oral PrEP remains a key HIV prevention modality, pill burden, and privacy are key barriers to oral PrEP uptake and continuation. Population Solutions for Health, PSI, and the Ministry of Health and Child Care are implementing a demonstration project to determine the acceptability and feasibility of using monthly DPV-R as an alternative to oral daily PrEP for HIV prevention.
METHODS: A two-arm prospective cohort design is being implemented across 8 districts in Zimbabwe. AGYW aged 18-25, screened as high-risk and eligible for PrEP chose between oral PrEP and DPV-R. Clients from both arms were followed up monthly between June and November 2022. Uptake and continuation rates were compared between the two arms for significant differences. Key informant interviews were conducted with clinicians involved in PrEP service provision.
RESULTS: A total of 1,535 AGYW were screened for PrEP, 1,466 were eligible and of these 1,128 (76.9%) (95% CIs: 74.7-79.7) chose DPV-R. Uptake was similar by age but differed significantly by residence, with higher uptake observed in rural (97.5% - 95%CI: 96.0-98.6) relative to urban (61.0% - 95%CI: 57.6.0-64.3) districts. Continuation rates were consistently higher among clients on DPV-R compared to oral PrEP as shown below. Five of 1,128 high-risk AGYW (0.4%) tested HIV positive since commencement on DPV-R compared to 1/338 (0.3%) receiving oral PrEP over the same period. Service providers reported high motivation for DPV-R among AGYW for its convenience and discretion.

CONCLUSIONS: DPV-R is a feasible and preferable PrEP option for AGYW in Zimbabwe and should be scaled up. More demand-generation activities are required in urban settings for improved uptake.