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Introduction <p>There is interest in PrEP uptake amongst young people at high risk of HIV. However, there is a significant decline in PrEP starting from three to six months after PrEP initiation, thus affecting PrEP persistence and continuation due to pausing and stopping of PrEP, with a few restarting it. Understanding why AGYW pause PrEP use and what motivates the few to restart is critical for enhancing PrEP adherence and continuation. We explored pausing of PrEP and restarting it amongst AGYW in an HIV prevention program, in Kampala, Uganda, to inform future HIV health education interventions aimed at strengthening PrEP continuation.</p> Methods <p>Between November 2023 and March 2024, a qualitative study using 17 follow up interviews was carried out in Kampala, Uganda at month six of PrEP initiation. Participants were purposively sampled from AGYW aged 14 to 24-years-old who were HIV-negative and at high risk of acquiring HIV. Data were transcribed verbatim, coded in Nvivo 14, analyzed thematically using iterative categorization, and interpreted using the Health Belief Model.</p> Findings <p>PrEP side effects were the major reason for missing and eventually pausing. Mobility of AGYW led to pausing PrEP, as some reported forgetting to travel with their pills or travelling with inadequate pills, and lack of access to PrEP in new locations. Anxiety about using PrEP during pregnancy and having other new health conditions requiring long-term oral medication led to pausing of PrEP. However, when they pause, they mitigate the risk by using other HIV prevention methods such as condoms. The major reasons for PrEP restart were high HIV risk awareness, including having multiple sexual partners of unknown status. Inconsistent condom use, due to men refusing or removing condoms and higher pay for condomless sex during sex work, motivated restarting PrEP. Lastly, future marriage prospects and getting into long-term relationships motivated AGYW to remain HIV-negative through PrEP use.</p> Conclusion <p>Some AGYW who pause PrEP intend to restart in the future and, during the period of pausing PrEP, they mitigate HIV risk by using other HIV prevention methods. Therefore, tailored comprehensive HIV-prevention messages should be implemented to normalize challenges in the PrEP journey, emphasizing the importance of restarting PrEP and of using other HIV prevention methods during the pause period to enhance HIV prevention persistence and continuation.</p>

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Oral PrEP pause and restart among adolescent girls and young women (AGYW) who initiated PrEP in an HIV prevention program in Kampala, Uganda: a qualitative study

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  • 发表日期：

    2026年7月7日

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  • Lazaaro Mujumbusi,
  • Ivy Kayesu,
  • Zam Nabalwanyi,
  • Yunia Mayanja

摘要

Introduction

There is interest in PrEP uptake amongst young people at high risk of HIV. However, there is a significant decline in PrEP starting from three to six months after PrEP initiation, thus affecting PrEP persistence and continuation due to pausing and stopping of PrEP, with a few restarting it. Understanding why AGYW pause PrEP use and what motivates the few to restart is critical for enhancing PrEP adherence and continuation. We explored pausing of PrEP and restarting it amongst AGYW in an HIV prevention program, in Kampala, Uganda, to inform future HIV health education interventions aimed at strengthening PrEP continuation.

Methods

Between November 2023 and March 2024, a qualitative study using 17 follow up interviews was carried out in Kampala, Uganda at month six of PrEP initiation. Participants were purposively sampled from AGYW aged 14 to 24-years-old who were HIV-negative and at high risk of acquiring HIV. Data were transcribed verbatim, coded in Nvivo 14, analyzed thematically using iterative categorization, and interpreted using the Health Belief Model.

Findings

PrEP side effects were the major reason for missing and eventually pausing. Mobility of AGYW led to pausing PrEP, as some reported forgetting to travel with their pills or travelling with inadequate pills, and lack of access to PrEP in new locations. Anxiety about using PrEP during pregnancy and having other new health conditions requiring long-term oral medication led to pausing of PrEP. However, when they pause, they mitigate the risk by using other HIV prevention methods such as condoms. The major reasons for PrEP restart were high HIV risk awareness, including having multiple sexual partners of unknown status. Inconsistent condom use, due to men refusing or removing condoms and higher pay for condomless sex during sex work, motivated restarting PrEP. Lastly, future marriage prospects and getting into long-term relationships motivated AGYW to remain HIV-negative through PrEP use.

Conclusion

Some AGYW who pause PrEP intend to restart in the future and, during the period of pausing PrEP, they mitigate HIV risk by using other HIV prevention methods. Therefore, tailored comprehensive HIV-prevention messages should be implemented to normalize challenges in the PrEP journey, emphasizing the importance of restarting PrEP and of using other HIV prevention methods during the pause period to enhance HIV prevention persistence and continuation.