A multi-country investigation of Pre-Exposure Prophylaxis preferences among young people at risk of HIV in sub-Saharan Africa 



Daily Pre-Exposure Prophylaxis (PrEP) is highly effective when adhered to, but its personal and public health benefits it limited by cost, user-acceptability and uptake.The Combined HIV Adolescent PrEP and Prevention Study (CHAPS) is a three-country study to investigate the acceptability of different PrEP regimens amongst young people in sub-Saharan Africa. We describe preferences for daily and on-demand PrEP in Cape Town and Johannesburg (South Africa), Entebbe (Uganda) and Harare (Zimbabwe).


Trained interviewers conducted cross-sectional, structured online surveys capturing socio-demographics, HIV risk behaviours, preferences for daily and on-demand PrEP (three dosing options; (1) two pills before and after sex, (2) two pills a few hours before sex, (3) two pills a few hours after sex). Data were analysed by site and gender using STATA.


Of 1339 participants aged 13-24 years enrolled, 49.7% were female, with most (70.7%) aged 18-24 years. The majority (78.9%) had sex, 83.3% a current partner, and 38.3% knew to have sex two hours in advance. Overall, 22.2% reported first sex aged 14 years or youngerand 50.8% weekly sexual activity. About half (51.4%) reported using a condom at last sex (55.6% females; 47.6% males). Twenty-five percent had ever heard of PrEP before the study (11.8% in Entebbe) and willingness to use PrEP was 95.8%. Overall, on-demand PrEP was the preferred option (59.5%) except for Cape Town, where 68.2% preferred daily PrEP. Males (65.2% vs 53.8%) preferred on-demand while females (46.3% vs 34.8%) preferred daily use. Despite an overall preference (59.5%) across sites for on-demand PrEP versus daily PrEP, more participants (36.8%) reported that taking daily PrEP would be the easiest compared to the on-demand regimen options (26.2%(1), 27.5%(2) and 9.5%(3)).


Awareness of PrEP was low, despite high willingness to use PrEP. PrEP demand creation needs to be reviewed, optimised and tailored to socio-demographic differences and designed in conjunction with young people. Additionally, although overall more participants in our sample preferred on-demand options, their sexual behaviour patterns may not support its use (e.g. sex events are unplanned for many). Strategies in sexual health education and promotion particularly around assessing and understanding sexual risk behaviour needs further exploration.