“When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya
BackgroundWomen of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offer...
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Frontiers Media S.A.
2025-07-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1552132/full |
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| author | Vallery Ogello Kristin Beima-Sofie Sandra Urusaro Mercy Awuor Annabell Dollah Winnie Atieno Cynthia Wandera Daniel Matemo Jennifer F. Morton Kenneth Ngure Kenneth Ngure John Kinuthia John Kinuthia Kenneth K. Mugwanya Kenneth K. Mugwanya |
| author_facet | Vallery Ogello Kristin Beima-Sofie Sandra Urusaro Mercy Awuor Annabell Dollah Winnie Atieno Cynthia Wandera Daniel Matemo Jennifer F. Morton Kenneth Ngure Kenneth Ngure John Kinuthia John Kinuthia Kenneth K. Mugwanya Kenneth K. Mugwanya |
| author_sort | Vallery Ogello |
| collection | DOAJ |
| description | BackgroundWomen of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offers insights into context-specific barriers and facilitators to its utilization.MethodsFrom September to November 2023, we conducted a qualitative study nested in a larger prospective, open-label clinical trial (FP-Plus). We conducted in-depth interviews (IDIs) with younger women (ages 15–24) and older women (ages ≥25) who declined, delayed, discontinued, or restarted PrEP during the study. IDIs were conducted at two FP clinics by trained Kenyan social scientists and were audio recorded, translated, and transcribed. We analyzed data using inductive and deductive thematic analysis through the lens of the theory of planned behavior (TPB) to explore experiences, beliefs, and rationale among women who made various PrEP decisions.ResultsWe interviewed 64 women, including 40 younger women and 24 older women, all of whom declined, delayed, discontinued, or restarted PrEP (n = 16 women/category). The median age of these women was 24 years (IQR, 23–30). The majority of participants (86%, 55/64) were using family planning methods, primarily injectables (42%, 23/64). PrEP discontinuation or restart was primarily influenced by changes in HIV risk dynamics. Agency and perceived HIV risk were pivotal factors in PrEP use decisions, shaping participants’ ability to practice effective prevention adherence (TPB: perceived behavioral control). Women who declined PrEP cited a lack of autonomy, partner influence, and insufficient information (TPB: social and subjective norms). Low self-efficacy influenced decisions to delay or decline PrEP (TPB: behavioral beliefs and attitudes). In addition, challenges with PrEP pill size, taste, and texture were perceived as barriers to swallowing pills among all groups of women. Participants expressed a preference for alternative PrEP formulations, such as injectable PrEP, due to perceived ease of use, privacy, and potential to support adherence.ConclusionPrEP discontinuation and restart cycles largely reflected changes in HIV risk. Women who decline or delay PrEP may benefit from personalized support to improve their autonomy, recognizing that HIV risk persists during periods of PrEP delay. |
| format | Article |
| id | doaj-art-e4a2a36673ae4235afd6c0003a6f1594 |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-e4a2a36673ae4235afd6c0003a6f15942025-08-20T02:41:32ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.15521321552132“When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in KenyaVallery Ogello0Kristin Beima-Sofie1Sandra Urusaro2Mercy Awuor3Annabell Dollah4Winnie Atieno5Cynthia Wandera6Daniel Matemo7Jennifer F. Morton8Kenneth Ngure9Kenneth Ngure10John Kinuthia11John Kinuthia12Kenneth K. Mugwanya13Kenneth K. Mugwanya14Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, KenyaDepartment of Global Health, University of Washington, Seattle, WA, United StatesDepartment of Global Health, University of Washington, Seattle, WA, United StatesResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaDepartment of Global Health, University of Washington, Seattle, WA, United StatesDepartment of Global Health, University of Washington, Seattle, WA, United StatesSchool of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, KenyaDepartment of Global Health, University of Washington, Seattle, WA, United StatesResearch & Programs, Kenyatta National Hospital, Nairobi, KenyaDepartment of Global Health, University of Washington, Seattle, WA, United StatesDepartment of Epidemiology, University of Washington, Seattle, WA, United StatesBackgroundWomen of childbearing age in sub-Saharan Africa (SSA) face a disproportionately high risk of HIV acquisition. Although oral PrEP has been universally scaled up for individuals at significant risk of HIV, its uptake and sustained use remain suboptimal. Understanding PrEP use decisions offers insights into context-specific barriers and facilitators to its utilization.MethodsFrom September to November 2023, we conducted a qualitative study nested in a larger prospective, open-label clinical trial (FP-Plus). We conducted in-depth interviews (IDIs) with younger women (ages 15–24) and older women (ages ≥25) who declined, delayed, discontinued, or restarted PrEP during the study. IDIs were conducted at two FP clinics by trained Kenyan social scientists and were audio recorded, translated, and transcribed. We analyzed data using inductive and deductive thematic analysis through the lens of the theory of planned behavior (TPB) to explore experiences, beliefs, and rationale among women who made various PrEP decisions.ResultsWe interviewed 64 women, including 40 younger women and 24 older women, all of whom declined, delayed, discontinued, or restarted PrEP (n = 16 women/category). The median age of these women was 24 years (IQR, 23–30). The majority of participants (86%, 55/64) were using family planning methods, primarily injectables (42%, 23/64). PrEP discontinuation or restart was primarily influenced by changes in HIV risk dynamics. Agency and perceived HIV risk were pivotal factors in PrEP use decisions, shaping participants’ ability to practice effective prevention adherence (TPB: perceived behavioral control). Women who declined PrEP cited a lack of autonomy, partner influence, and insufficient information (TPB: social and subjective norms). Low self-efficacy influenced decisions to delay or decline PrEP (TPB: behavioral beliefs and attitudes). In addition, challenges with PrEP pill size, taste, and texture were perceived as barriers to swallowing pills among all groups of women. Participants expressed a preference for alternative PrEP formulations, such as injectable PrEP, due to perceived ease of use, privacy, and potential to support adherence.ConclusionPrEP discontinuation and restart cycles largely reflected changes in HIV risk. Women who decline or delay PrEP may benefit from personalized support to improve their autonomy, recognizing that HIV risk persists during periods of PrEP delay.https://www.frontiersin.org/articles/10.3389/fmed.2025.1552132/fullHIV preventionPrEP use decisionsfamily planning clinicsimplementation sciencewomen of childbearing age |
| spellingShingle | Vallery Ogello Kristin Beima-Sofie Sandra Urusaro Mercy Awuor Annabell Dollah Winnie Atieno Cynthia Wandera Daniel Matemo Jennifer F. Morton Kenneth Ngure Kenneth Ngure John Kinuthia John Kinuthia Kenneth K. Mugwanya Kenneth K. Mugwanya “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya Frontiers in Medicine HIV prevention PrEP use decisions family planning clinics implementation science women of childbearing age |
| title | “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya |
| title_full | “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya |
| title_fullStr | “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya |
| title_full_unstemmed | “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya |
| title_short | “When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya |
| title_sort | when he is around i ll take the prep but when he is not i will not take prep key influences on prep use decisions among women attending family planning clinics in kenya |
| topic | HIV prevention PrEP use decisions family planning clinics implementation science women of childbearing age |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1552132/full |
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