Improving HIV Oral PrEP Continuation Among Adolescent Girls and Young Women (AGYW) Evidence from a novel branding and service delivery strategy in Zimbabwe

BACKGROUND: Nearly 1,000 Adolescent Girls and Young Women (AGYW) are infected by HIV daily in sub-Saharan Africa. The complex mix of Covid-19, social, cultural, and religious barriers make it challenging to reach AGYW with HIV prevention. In Zimbabwe, PrEP continuation remains a challenge among AGYW. Population Solutions for Health implemented a demand generation intervention dubbed the 'V-campaign' in 3 Zimbabwean districts. The intervention comprised implementing community interpersonal strategies delivered by trained peer mobilizers and health care workers, offering PrEP at community outreach sites, and issuing a V-'Starter Kit' which enables taking PrEP in a discrete, fashionable way that promotes self-care and boosts confidence.
METHODS: V was implemented in 3 intervention districts between April 2021'December 2021, with 3 control districts for comparison. We hypothesized that AGYW in the intervention districts will have longer continuation rates at 3 months after initiation on PrEP compared to those in control districts. Using routinely collected data, we compared one-, two- and three-month PrEP continuation rates among AGYW in the intervention (N=1020) versus control (540) districts. Virtual qualitative interviews and site monitoring explored implementation fidelity and barriers and facilitators to contextualize trends in continuation data.
RESULTS: Intervention districts performed significantly better compared to control districts (Figure 1): Overall, 3-month continuation rates increased from 41% ((38%-43% (95% CI)) to 62% (60%-65% (95% CI)) in the intervention districts (27% increase) compared to a 13% increase in the control districts. Qualitative data indicated high levels of intervention acceptability and feasibility among young women and providers.


CONCLUSIONS: The V-campaign has shown a significant impact in retaining AGYW on PrEP. The intervention will be scaled up to other districts in Zimbabwe with low uptake and poor PrEP continuation. Programs that seek to scale up PrEP continuation can adopt V to bring care closer to AGYW and enhance peer support and build self-empowerment.