Background: Oral PrEP is offered to populations at substantial HIV risk in Kenya, South Africa, and Zimbabwe, including adolescent girls (AG) 15-17 and young women (YW) 18-24. We examined providers'' attitudes and experiences delivering PrEP to AGYW to inform provider training and service delivery.
Methods: We surveyed providers (Kenya=290, South Africa=192, Zimbabwe=127) and conducted follow-up qualitative interviews (Kenya=40, South Africa=48, Zimbabwe=27). Participants included clinicians, nurses, counselors, pharmacists, and community-based workers at public and private facilities; 334 had experience with PrEP delivery, and 274 did not. We descriptively analyzed survey data in STATA 13 and thematically analyzed interviews using NVivo 11.
Results: Although PrEP delivery differs across countries, providers shared similar attitudes. While some survey participants agreed “it''s better to tell sexually active unmarried women (AG 49%, YW 36%) to abstain from sex rather than give her PrEP,” providers in interviews acknowledged that many girls engage in sex before 18 and could benefit from PrEP. More providers (75%) believed YW were responsible enough to take PrEP consistently compared to AG (49%), stating that delivering services to YW is easier because they are “more mature” while some AG “don''t listen.”
Providers delivering PrEP to AGYW reported that clients'' lack of PrEP knowledge and lack of disclosure were barriers to uptake, adherence, and retention. Side effects, lack of relationship power, and access barriers were also cited in Kenya. Providers thought AGYW should disclose PrEP use to parents (34% AG) and partners (52% AG, 57% YW; highest in Kenya, lowest in South Africa) to facilitate adherence but were concerned about negative reactions from parents/partners because of low PrEP awareness and HIV stigma. Providers shared strategies they used to help AGYW use PrEP successfully, including intensive adherence and relationship counseling, phone follow-ups, home visits, peer counseling, and community awareness-raising. Additional differences between countries and AG/YW will be presented.
Conclusions: Providers were generally supportive of PrEP for AGYW, with more reservations about AG. Results are informing provider training in these countries to address these reservations. Additional community sensitization about PrEP as a prevention option for AGYW?particularly targeting parents and partners?could make it easier for AGYW to use PrEP.

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