Analyzing Obstacles and Prospects of PrEP Continuation among the Adolescent Girls and Young Women under the Malawi EMPOWER Activity

Authors: John Kumwenda¹, Ruth Kundecha¹, Lawrence Mpende¹

Contacts: kumwendajohn@gmail.com, 0994300345

Track A: Combination prevention

¹CHAM, Malawi EMPOWER

Introduction 

The EMPOWER project is funded by USAID and will run from March 5, 2020, to March 4, 2025. It is implemented by FHI 360, along with local organizations CHAM and Pakachere. The project aims to help the Government of Malawi control the spread of HIV among adolescent girls and young women aged 10-24. Starting in 2021, EMPOWER began focusing on providing PrEP to prevent HIV transmission among high-risk individuals. This study explored the challenges and opportunities to improve PrEP continuation for girls and young women in Machinga.

Methodology

The study used a cross-sectional design employing a qualitative approach. Key informant interviews and secondary data collection were used. Simple random and purposive sampling techniques were used to select four health facilities and four key informants from the PrEP distribution facilities. Interviews were conducted via phone calls, and secondary data was gathered from the DHIS2 database and previous studies.

Results 

The data from DHIS2 was analyzed using Excel. The results show low continuation rates of PrEP among girls in quarter 2 of the 2023 financial year with an initial intake of 715 while only 342 continued on PrEP. The results from the interviews which were thematically analyzed showed that limited awareness and knowledge about PrEP, Stigma and discrimination, the fear of judgement and social exclusion and long distances discourage girls from continuing PrEP. This study builds upon a previous initiative conducted in 2022, which also identified similar obstacles in delivering PrEP.

Conclusion

Long distances and the fear of judgement and social exclusion emerge to be the major obstacles to PrEP continuation. Addressing awareness gaps and distance barriers can improve HIV among adolescent girls in Machinga.

Recommendations 

Key recommendations include: raising awareness and knowledge about PrEP, combating stigma and discrimination, and enhancing community-based PrEP initiation.