Nurse-led PrEP Delivery among Young Women: A Pilot Study in Uganda

The global decline in HIV infections among adolescent girls and young women (AGYW) is much slower than their male peers. HIV pre-exposure prophylaxis (PrEP) uptake is low among AGYW perhaps because it is accessed through clinicians in HIV clinics that are highly medicalized and associated with stigma. We aimed to determine the feasibility and acceptability of an alternative PrEP delivery model, led and independently run by nurses. We conducted a pilot study among a cohort of 59 PrEP-eligible AGYW at Kawaala Health Centre IV in Kampala, Uganda. Acceptability was defined as the proportion of eligible AGYW who initiated PrEP. We used a time and motion study to evaluate feasibility by estimating the time spent by AGYW to complete a PrEP visit and by nurse-providers in conducting PrEP-related activities. We measured PrEP adherence using self-report and estimated PrEP retention as the proportion returning for month one, three, and six study visits. The median age of AGYW was 22 years (Interquartile range [IQR] 21-23); 47% (28/59) did not know their partner’s HIV status and 2% (1/59) had a partner with HIV. At study enrolment, 37% (22/59) of participants chose injectable contraceptives, 47% (28/59) had ever heard of PrEP but only 3% (2/59) had ever used PrEP. PrEP-initiation visits were estimated to last ~95 minutes inclusive of waiting time and workflow interruptions but not research procedures and COVID-19 screening. Median retention was 5 months; 49 (83%) returned at month one, 37 (63%) at month three, and 24 (41%) at month six. Self-reported adherence was good (≤3 pills missed in 30 days) for 65% (32/49) participants at month one but poor (≥9 pills missed in 30 days) at the month two and four visits. Nurse-delivered PrEP was acceptable and feasible for AGYW attending a family planning clinic in Uganda. HIV programs should consider integrating PrEP into existing sexual and reproductive health services for young women.