Supporting adolescent girls and young women to adhere to oral PrEP; experiences of counsellors at the Kampala site

BACKGROUND: Depending on adherence to medication, overall oral PrEP efficacy has been shown to range from no efficacy to that above 90% in large clinical trials. Several studies have shown that adherence is influenced by different factors including; fear of side effects, stigma of taking ARVs and community myths and misconceptions. Counsellors and study teams have to be well equipped to support adolescents' adherence to daily oral PrEP. We aim to describe the experiences of counsellors as they support the adolescent girls and young women (AGYW) to adhere to daily oral PrEP in the MTN-034/ REACH study.
METHODS: Prior to REACH implementation, formal trainings were held for counselors on adherence support required for AGYW. Materials used included flip charts, product use instructions, adherence menu options and manuals to guide the audio recorded sessions. Bi-weekly de-brief sessions are held with the counselling teams to discuss best practices and challenges in supporting participants to adhere to daily oral PrEP. Additionally, counsellors share experiences in engaging participants in weekly meetings and also document feedback from peer review sessions in detailed reports.
RESULTS: Of 23 participants, 44% adhered to daily oral PrEP well while 54% required more support. Of these, 31% had poor adherence, claimed to be swallowing their tablets correctly and that the study team used poor adherence testing methods and were not relating well with them. After Informed consent discussion, the team learnt that about 10% were joining due to peer pressure and had partial understanding of oral PrEP. Education sessions were conducted prior to randomization and subsequent correct understanding of the study was documented. The team has learned that dealing with adolescents requires patience and active listening while being non-judgemental. These skills have been integrated in the various counselling sessions that have been useful to improve adherence. Additionally, integration of peers that have used Truvada for PrEP or HIV treatment in group sessions to share their lived experience, is also useful to help AGYW adhere to daily oral PrEP.
CONCLUSIONS: Supporting adolescents to adhere to oral PrEP is challenging and can be resolved if counsellors are adequately equipped with the skills and knowledge.