BACKGROUND: Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. South Africa started rolling out PrEP in 2016, initially for selected population groups before expanding access to more people. However, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them acquiring HIV at high rates. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa.
METHODS: We conducted a population-based prospective study in 22 SDPs from July 2021 to June 2022 in uMgungundlovu – a district with 24% HIV prevalence among males aged 15-49 years in KwaZulu-Natal province. Sexually active ABYM aged 15 – 35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We defined PrEP initiation according to national guidelines. We described baseline characteristics using summary statistics and reported PrEP initiation proportions overall and by SDPs. PrEP initiation for each participant was extracted against local medical records.
RESULTS: The study included 1 078 ABYM were recruited from 22 SDPs, with more than half aged 15-24 years (n=590, 55%) and 45% (n=488) aged 25-35 years. Among 1 078 participants who were eligible for PrEP, 13% (n=141) were started on PrEP. Among the participants who were started on PrEP, more than half (52%, n=74) were from high schools and TVET colleges, compared with community-based youth zones (26%, n=37) and healthcare facilities (21%, n=30). Participants were 18.4 (95% CI: 4.79 – 9.18) and 32.6 (95% CI: 6.49 -16.4) times more likely to initiate PrEP in youth zones and schools, respectively, compared to clinics (p<0.001).
CONCLUSIONS: PrEP initiation rates were low among AYBM in KwaZulu-Natal, South Africa. Providing PrEP in high schools and TVET colleges, and community-based SDPs resulted in improved PrEP initiation rates when compared with traditional facility-based model. High schools and TVET colleges, and community-based SDPs could serve as important additional models to the traditional facility-based model for improving PrEP accessibility and initiation among ABYM.

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