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Adolescent-Centered HIV Prevention: Perspectives on Acceptability of Oral Antiretroviral Pre-exposure Prophylaxis for Adolescents in a Global Priority Setting

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Abstract

With oral antiretroviral pre-exposure prophylaxis (PrEP) rollout expanding to include adolescents in South Africa, research is needed to better understand perceptions of PrEP acceptability among adolescents and clinical service providers. We conducted an exploratory mixed-methods study among 57 adolescents, 16–17 years of age, living with and without HIV, and 25 clinical service providers in Cape Town, South Africa from 2015 to 2016. Cross-sectional survey and semi-structured qualitative interview data were used to explore (1) willingness to use PrEP and support partner PrEP use among adolescents living with and without HIV, (2) willingness to prescribe or support prescription of PrEP among service providers, and (3) perceptions of barriers and facilitators to PrEP implementation and interpretations of PrEP efficacy messaging for adolescent HIV prevention among all participants. Acceptability of PrEP among participants was high. Support for PrEP uptake was linked to messages that positively framed PrEP’s protection potential (i.e., success- versus failure-framed messaging) among both adolescents and providers. Adolescents living without HIV endorsed high willingness to use PrEP and adolescents living with HIV endorsed high support for partner PrEP use. However, both groups noted that potential side effects, stigma, and PrEP’s partial efficacy may hinder uptake. Clinical service providers endorsed PrEP for sexually active adolescents and shared stigma and efficacy concerns. Further, service providers expressed desire for adolescent-tailored training and integration of PrEP delivery into primary care and family planning services. Efforts to educate adolescents and service providers about PrEP should consider how message framing may influence acceptability. Community PrEP education and adolescent-friendly delivery should be prioritized to alleviate predicted PrEP stigma and facilitate uptake.

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Acknowledgements

This research was supported by NIH Grants R21AI116309, F31MH119965, and K01MH096646.

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516, USA

    Danielle Giovenco

  2. Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA

    Caroline Kuo & Don Operario

  3. Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA

    Caroline Kuo

  4. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Caroline Kuo & Jacqueline Hoare

  5. Columbia Law School, New York, NY, USA

    Kristen Underhill

Authors
  1. Danielle Giovenco
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  2. Caroline Kuo
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  3. Kristen Underhill
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  4. Jacqueline Hoare
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  5. Don Operario
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Correspondence to Danielle Giovenco.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics Statement

All study procedures were approved by ethical review committees at Brown University (Protocol #1207000666) and University of Cape Town (Protocol #HREC 072/2013) and were conducted in accordance with the 1964 Helsinki Declaration.

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Informed assent and parental or caregiver consent was obtained for all participants.

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Giovenco, D., Kuo, C., Underhill, K. et al. Adolescent-Centered HIV Prevention: Perspectives on Acceptability of Oral Antiretroviral Pre-exposure Prophylaxis for Adolescents in a Global Priority Setting. Arch Sex Behav 50, 2921–2931 (2021). https://doi.org/10.1007/s10508-021-02052-2

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  • DOI: https://doi.org/10.1007/s10508-021-02052-2

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