(P300) Evaluating Pre-Exposure Prophylaxis Uptake, Adherence and Persistence Outcomes among Adolescents and Young Adults Aged 10-24: A Global Systematic Review, Meta-analysis, and Meta-synthesis.

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

Gifty Marley, MMed, PhD (she/her/hers)

Post-doctoral Fellow
University of North Carlolina at Chapel Hill - Project China, Guangdong, China (People's Republic)

Co-author(s)

Dw

Daniel woznica

University of Illinois Chicago, United States
WA

Wei Ai

Nanjing Medical University, China (People's Republic)
SH

Siyue Hu

SESH Global, China (People's Republic)
WN

Wes Nijim

University of Illinois Chicago, United States
Rayner Kay Jin Tan, PhD

Postdoctoral Fellow
University of North Carolina Project-China, United States
JT

Joseph D. Tucker

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK, United States
WT

Weiming Tang

Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, United States

Background: Pre-exposure prophylaxis (PrEP) is a highly effective intervention for preventing HIV infection. This review aimed to synthesize evidence related to PrEP care cascade outcomes among adolescents and young adults (AYA, 10-24 years old) to inform the development of tailored HIV prevention interventions within this population.

Methods: We searched six databases for peer-reviewed English articles published from January 1, 2010, to February 11, 2022, with no geographic limitation. Quantitative and qualitative studies that reported PrEP care cascade outcomes among AYA were eligible for inclusion. Studies were grouped by stage of the PrEP care cascade (uptake, adherence, and discontinuation and re-initiation) and pooled in a random effects model using R. We conducted a thematic meta-syntesis of data from qualitative studies using MAXQDA software.

Findings: Out of 4545 de-duplicated studies screened, 87 were included. 62% (n=54) of the studies were from high-income countries (HICs), 27% (n=24) of studies targeted adolescent and young MSM (AYMSM), and 25.3% (n=22) engaged adolescent girls and young women (AGYW). Overall, PrEP adherence was lower in lower/middle income countries (LMICs) than HICs (36% vs. 66% adherence rate at 6 months, respectively). By population type, the pooled PrEP adherence rate at six months was lowest among AGYW (33% adherence ) compared to AYMSM (72%) and mixed populations (53%). Seven studies explored factors associated with PrEP discontinuation and eight studies assessed daily oral PrEP persistence. PrEP providing relief from fear of HIV infection and perceived HIV risk were the most explored facilitators of PrEP uptake and adherence. In contrast, lack of parental support, low perceived HIV risk, stigma, and fear of side effects were the most cited barriers.

Conclusion

AGYW in LMICs have the worst PrEP outcomes. This may be due to a disproportionate allocation of PrEP resources to LMICs relative to HIC, and current programs being centered on sexual and gender minority youths in most LMICs. More tailored strategies that involve parents/guardians and stigma-reduction interventions are needed to scale up PrEP cascade outcomes among AYA, especially among AGYW, in LMICs.