Exploring Experiences of the My PrEP Decision Support Tool and Counselling Services Among Adolescent Girls and Young Women in Johannesburg

Abstract

Introduction Adolescent Girls and Young Women (AGYW) remain the most vulnerable group to HIV, accounting for 63% of all new infections in 2021 in the Sub-Saharan region. South Africa has the same challenge, with AGYW contributing almost a third of the number of People Living with HIV (PLHIV). The World Health Organization (WHO) recommends Pre-exposure Prophylaxis (PrEP) as an intervention for HIV prevention for at-risk groups such as AGYW. However, challenges of PrEP uptake persist among the group. Demand generation interventions on PrEP uptake are crucial in supporting hesitancy and decisional conflict AGYW may have. This study explored at risk AGYW’s experiences of using a decision support tool (DST) called “My PrEP” and standard of care counselling, to understand the influence these services may have played in their PrEP uptake decision. Methods This is a secondary analysis of qualitative data collected in 2020 as part of a randomised controlled trial (RCT) on the effectiveness of the DST on PrEP uptake decision of AGYW visiting Jeppestown Clinic in Johannesburg. The trial consisted of two groups: group one received a tablet with “My PrEP” DST and standard of care counselling, and the other group received one with general health information as well as counselling. In-depth Interviews (IDI)s were conducted at the Wits RHI offices in Hillbrow, Johannesburg with AGYW from both control and intervention groups soon after their experience. IDI transcripts are the sources of this qualitative data. The current study focused on the group exposed to the DST and counselling. Results The study demonstrated a high level of acceptability for the DST among AGYW. Critical factors contributing to this acceptability included the tool's simplified language, visual aids, and its alignment with participants' lived experiences. The DST effectively facilitated informed decision-making by enhancing knowledge and supporting self-efficacy, resulting in more engaging healthcare interactions. Participants appreciated the independence and ethical considerations promoted by the DST, underscoring the importance of respecting autonomy in health interventions. Furthermore, the study highlighted the significant role of dual support from the DST and counselling in enhancing AGYW’s comprehension, self-efficacy, and decision-making vi regarding PrEP uptake. The DST addressed informational gaps not covered by counselling and aided in personal and partner risk assessment. To maximise its impact, efforts should focus on improving mobile accessibility, multi-platform dissemination, and refining content to ensure it comprehensively provides information. Conclusion As PrEP demand generation for at-risk groups such as AGYW progresses, understanding leverage points for PrEP uptake interventions is essential in addressing HIV. While the use of DSTs is relatively new in Sub-Saharan Africa (SSA), countries like South Africa may particularly benefit from such innovations targeting at-risk groups