ArticleJournal of the International AIDS Society2025
PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub-Saharan Africa.
Article in Journal of the International AIDS Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- A Population-Based HIV Vaccine Efficacy Trial Design: Statistical Framework and Design Considerations.Vaccines · 2026Review
- Long-acting HIV pre-exposure prophylaxis adherence and discontinuation: a global systematic review and meta-analysis.EClinicalMedicine · 2026Article
- Preclinical Pharmacokinetics of a Triple-Combination Intravaginal Ring for HIV Prevention.Pharmaceutics · 2026Article
- Long-Acting HIV Pre-exposure Prophylaxis Preferences Through Pregnancy and the Postpartum Period Among Women in Kenya: A Latent Transition Analysis.AIDS and behavior · 2026Article
- Willingness to pay for injectable HIV pre-exposure prophylaxis among male and female sex workers in Uganda.Archives of public health = Archives belges de sante publique · 2026Article
- Beyond Efficacy: The Access, Delivery Systems, Acceptability, Persistence, and Transition Management "ADAPT" Framework for Long-Acting Injectable PrEP in Sub-Saharan Africa.HIV/AIDS (Auckland, N.Z.) · 2026Article
- Expanding access to a choice-based multi-method PrEP market for HIV prevention.Journal of the International AIDS Society · 2025Article
- Preferences for long-acting injectable HIV pre-exposure prophylaxis service delivery among male and female sex workers in Uganda: A discrete choice experiment.PLOS global public health · 2025Article
- Lenacapavir for HIV Prevention in Africa: Opportunities, Barriers, and Policy Priorities.Journal of the International Association of Providers of AIDS CareReview
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35 authors.
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Abstract
introductionHIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre-exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa.
methodsThe CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis.
resultsOf 3967 participants, 44.9% were AGYW (15-24 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants ≤ 24 years (p = 0.007) and participants who were pregnant (p = 0.002) or breastfeeding (p < 0.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (p < 0.001). Of participants returning for ≥ 1 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (p < 0.001) and those ≤ 24 years (p < 0.001), PrEP naïve at enrolment (p < 0.001) or not currently using contraception (p = 0.03).
conclusionsWe demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed.
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