Background: AIDS is the leading cause of death among adolescents in sub-Saharan Africa. In Kenya, an estimated 18,000 adolescents acquire HIV annually. Oral pre-exposure prophylaxis (PrEP) for HIV, adopted by the Kenyan government in 2017, offers a new approach to prevention of new infections, including among adolescent girls. Little is known about adolescent girls accessing routine PrEP services in the context of national scale-up programs. Jilinde is a program funded by the Bill & Melinda Gates Foundation supporting roll out of PrEP for key and vulnerable populations, including adolescent girls and young women (AGYW) in public clinics, private clinics, and drop-in-centers (DICEs) in Kenya.
Methods: We report demographic and reported risk behaviors of adolescent girls, ages 15 - 19 years, initiating PrEP from February 2017 to December 2018. The adolescents received either static or outreach services from 93 Jilinde-supported clinics. Retrospective analysis was conducted on de-identified client data sourced from the PrEP medical record form approved by the Ministry of Health of Kenya.
Results: Among 21,578 clients initiating PrEP, 1783 (8%) were adolescent girls, only 16% of whom were in school. DICEs, clinics designed primarily for sex workers and men who have sex with men, were the preferred PrEP outlet for adolescent girls, with 67% accessing services in DICEs. Slightly over half (51%) were referred to PrEP sites through peer networks. Risk behaviors underlying PrEP initiation included inconsistent condom use (96%), engaging in sex with partner considered high-risk and of unknown HIV status (83%), transactional sex (46%) and sex under influence of drugs/alcohol (34%).
Conclusions: Within the context of Jilinde, over half of adolescent girls reached were engaged in highly risky behavior (transactional sex, inconsistent condom use, partners of unknown status), and were referred for services by peers. In addition, most accessed PrEP through DICEs that may provide them with services but are not designed to meet the unique needs of adolescent girls. Efforts to make PrEP accessible to AGYW at risk of HIV acquisition should include restructuring the service delivery model, and mitigating the high-risk behaviors.

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