ArticleAIDS (London, England)2026
Unraveling PrEP persistence: mental health and substance use among adolescent girls and young women in an implementation program.
Article in AIDS (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo examine associations between mental health, substance use, and pre-exposure prophylaxis (PrEP) persistence among South African adolescent girls and young women (AGYW).
designA longitudinal analysis of a decentralized PrEP implementation program.
methodsWe analyzed data from FastPrEP, a youth-focused program delivering PrEP with peer-navigator support through community-based mobile clinics and public clinics near Cape Town. Female participants aged 15-29 years who received a one-month supply of daily oral PrEP at program enrollment were included. Moderate to severe depression/anxiety symptoms (PHQ-4 ≥6) and hazardous alcohol use (AUDIT-C ≥3) were assessed at enrollment. Log-binomial regression was used to estimate overall and age-stratified adjusted prevalence ratios (aPRs) for associations with short-term PrEP persistence at the one-month follow-up visit.
resultsFrom April 2022 to April 2024, 6,271 AGYW were enrolled in FastPrEP and dispensed daily oral PrEP (median age 21 years); 75% enrolled at mobile clinics. At enrollment, 8% reported moderate to severe depression/anxiety symptoms and 50% hazardous drinking. Only 10% returned and received PrEP within a 28-day window of their one-month follow-up visit. Moderate-severe depression/anxiety symptoms were associated with greater PrEP persistence (aPR = 1.37, 95% confidence interval [95% CI] 1.04-1.79), as was hazardous drinking (aPR = 1.46, 95% CI 1.23-1.75). Associations were strongest among AGYW aged 15-19 years (depression/anxiety: aPR = 1.71, 95% CI 1.11-2.65; hazardous drinking: aPR=1.60, 95% CI 1.16-2.19).
conclusionContrary to expectations, mental health and substance use challenges were associated with greater short-term PrEP persistence, particularly among younger AGYW. These findings suggest that youth-centered, peer-supported delivery models may help sustain engagement among higher-risk AGYW.
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