TUAC0304
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Title
PrEP re-initiation after interruption by adolescent girls and young women in Kenya and South Africa
Presenter
Victor Omollo
Authors
V. Omollo1, J. Odoyo1, D. Travil2, E. Rousseau3, L. Kidoguchi4, L.-G. Bekker3, S. Delany-Moretlwe2, J. Morton4, J. Haberer5, G. O'Malley4, G. Barnabee4, A. van der Straten6, R. Hefron4, R. Johnson4, C. Celum4, E.A. Bukusi1, J. Baeten4
Institutions
1Kenya Medical Research Institute (KEMRI), Kisumu, Kenya, 2Wits Reproductive Health & HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Johanesburg, South Africa, 3Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa, 4University of Washington, Seattle, United States, 5Massachusetts General Hospital, Boston, United States, 6Women's Global Health Imperative, RTI International, San Francisco, United States

Background: African adolescent girls and young women (AGYW) are at high risk of HIV. PrEP is highly effective in reducing HIV acquisition, but interruptions are common. We explored PrEP re-initiation in a PrEP implementation project among African AGYW.
Methods: POWER is a PrEP implementation science project among AGYW ages 16-25 in Kisumu, Kenya, Johannesburg and Cape Town, South Africa. Women are offered PrEP and have visits at month 1 and then quarterly. Patterns of PrEP use were measured using pharmacy records; PrEP interruption was defined as PrEP not dispensed at a visit or a gap of >14 days without PrEP due to a missed visit. Reasons for interruptions were documented in chart notes. This analysis characterizes PrEP interruptions and re-initiation within 6 months among AGYW who initiated PrEP at enrollment.
Results: Between June 2017-November 2018, 1367 AGYW (median age 20) were enrolled. Most, (83%) were single, 28% reported never using condoms with their current partner(s), and 36% knew the HIV status of their partner(s). Most (92% 1254/1367) accepted PrEP. Of 970 women with 6 months of follow-up after PrEP initiation, 917/970 (95%) had a PrEP interruption; most (874/917, 95%) were due to late or missed visits. Of 644 women who could have had 6 months of follow-up after an interruption, 25% (160/644) re-initiated PrEP: 154 after a missed/late visit, 5 after declining a refill, and 1 after a clinical hold. PrEP re-initiations occurred within a month of interruption in 59% (median 38 days, interquartile range 26-57), and a higher proportion (87%) restarted within a month among those whose interruption occurred after the first 2 months of PrEP. Women reported travel and relationship dissolution as reasons for interruptions. Importantly, women sometimes did not view these periods as interruptions (e.g. intentional delays of PrEP initiation after the first prescription, attending follow-up visits late, or periods of PrEP non-use due to sexual abstinence).
Conclusions: PrEP uptake was high among African AGYW. PrEP interruptions were common, often intentional, and one-quarter re-initiated PrEP, typically in 1-2 months. In evaluating PrEP programs, interruptions, reasons for discontinuation, and re-initiation patterns should be monitored to assess the delivery and impact of PrEP.