Working under the OPTIONS project has ignited my interest in

Working under the OPTIONS project has ignited my interest in learning more about HIV prevention, especially this new method of using ARVs for HIV prevention. I have been working in this project for close to three years and PrEP has become part of my life. OPTIONS is a consortium that expedites and sustains access to ARV based HIV prevention. In support of this goal, our team conducted operations research to gain data and evidence that allowed us to provide tailored and targeted technical assistance to the National Department of Health (NDoH).

Being part of the research team that undertook the operations research – a study called Advancing PrEP Comprehensive and Combined Operations Research of Services for Sex workers and men who have sex with men (ACCESS) – has opened my eyes to the gaps that still exist in the HIV prevention puzzle.

I am passionate about HIV prevention issues among AGYW, especially university students, for which there are limited data. Therefore, I feel that by targeting this population for my PhD studies not only would I be following my passion, but I’d also be collecting data needed towards the national understanding of PrEP use in this population.

Young women aged 20–24 years, are four times more likely than men to be living with HIV and AGYW have the highest HIV incidence rate of any age or sex cohort (1–3) In South Africa, about 1745 new infections occur among this age group every week (2). South Africa bears the highest burden of HIV in the world with an estimated 7.

Get quality help now
Marrie pro writer

Proficient in: Aids

5 (204)

“ She followed all my directions. It was really easy to contact her and respond very fast as well. ”

+84 relevant experts are online
Hire writer

1 million people living with HIV at the end of 2016(1,3). Since South Africa is the epicenter of HIV infection, I would like to make a difference and be part of the HIV prevention solution by conducting research, which would help fight this scourge. Finding safe and effective HIV prevention options has been an ongoing public health challenge. I have always felt a burden of HIV in my extended family and the community at large, hence I strongly feel obliged to offer solutions through research. I am eager to be part of the HIV prevention solution in Sub Saharan Africa where AIDS remains a leading cause of death among adolescents and is the second leading cause of death globally according to the World Health Organization (4). Furthermore, this is the only age group where AIDS related deaths are not decreasing(2). By conducting the proposed research, I will be contributing towards the first goal of the South African National Strategic Plan (NSP 2017-22), which aims to accelerate prevention, to reduce new HIV, TB, and sexually transmitted infections(1). Therefore, my proposed study is aligned to the national strategy. Prevention is always better than cure hence I believe that pursuing a PhD focusing on HIV prevention is a worthwhile investment.

My interest in PrEP adherence is informed by literature and experience. Studies report that adolescents may struggle with adherence compared to older populations and may need targeted adherence support tailor-made to their age and life style (4,5). PrEP is an effective biomedical HIV prevention method, which however requires high adherence for it to be efficacious. Drug adherence relates to one’s pattern of regimen use (6). In the South African context where PrEP has not been fully accepted there may be uptake and adherence challenges that are not yet known but require documentation through dedicated research. Given these real and perceived challenges, it is important to investigate young university, female students’ experiences including facilitators and barriers to effective PrEP use among this group to understand factors which promote or deter its effective use.

1. Describe / present / discuss three possible research questions that could be asked in this area (with reference to the literature). (maximum 1 page)

The following are the research questions the proposed study attempts to address:

1) What are the facilitators and barriers to PrEP initiation among AGYW in universities?

2) What is the level of PrEP adherence among AGYW in universities?

3) What are the adherence strategies employed by AGYW PrEP users in South African universities?

1) What are the facilitators and barriers to PrEP initiation among AGYW in universities?

Studies have documented the facilitators and barriers to PrEP for some key populations such as the men who have sex with men (MSM) and female sex workers (FSWs). Some of the cited barriers from the clinical trials include stigma and low risk perception (7). There is a dearth of knowledge on AGYW barriers and facilitators to PrEP access in real world settings. The existing literature points to a general concern about young women having less agency to use PrEP and facing stigma about being sexually active and having limited access to youth friendly services as potential barriers to PrEP initiation (8). Implementation science research on PrEP assessing young women’s motivation for HIV prevention is therefore critically needed. It would be important to document the facilitators and barriers to AGYW PrEP initiation from the AGYW’S perspectives as this will inform the national PrEP roll out.

2) What is the level of PrEP adherence among AGYW in universities?

Little is known about PrEP use in real world settings. The existing literature reports on clinical trials and demonstration projects participant’s adherence of the study product. In clinical trials where only a minority of participants adhered to PrEP (less than 30% adherence), such as in the (VOICE) and Fem-PrEP trials, no PrEP efficacy was established (7). Poorer adherence to PrEP was reported by the younger women (8,9). The efficacy of PrEP is known to diminish with decreased use.

The WHO recommends the use of PrEP for people at substantial risk of HIV infection giving priority to populations with an incidence of 3 per 100 person-years or higher (4). In response to this recommendation the South African NDoH has been rolling out PrEP to key populations in a phased approach starting with FSWs followed by MSM and recently to AGYW. No adherence measurement is being done through the national programme as adherence monitoring is not standard practice. I feel it is important to measure adherence levels, which can be done using hair samples, and compare with self-reported adherence, which is prone to recall bias. Documenting the level at which AGYW at universities are adhering to PrEP, would provide effective PrEP adherence levels in a real-world setting as PrEP is different from life-long treatment such antiretroviral treatment.

3) What are the adherence strategies employed by AGYW PrEP users in South African universities?

Evidence form clinical trials showed that PrEP adherence is a challenge. The Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial design was influenced by a socio-economic framework where the individual’s adherence behavior is positioned within a broader context of household, organizational, and community influences (7). For the AGYW to effectively take PrEP, it is important to understand the context in which the individual operates as this may influence the adherence patterns and strategies. PrEP adherence strategies employed by adults, including m-health interventions, use of reminders, and peer support (9) may not be the same strategies that work for adolescents and further studies should evaluate this (9). Documenting the adherence strategies employed by university AGYW is therefore important.

Cite this page

Working under the OPTIONS project has ignited my interest in. (2019, Dec 09). Retrieved from

Let’s chat?  We're online 24/7