Meeting South African adolescent girls and young women who experience intimate partner violence where they are: Developing an implementation strategy for linkage to PrEP options

PROJECT SUMMARY Intimate partner violence (IPV) is a serious public health concern affecting adolescent girls and young women (AGYW) in South Africa, with a cumulative incidence of physical or sexual IPV among AGYW aged 15-19-years of 37%. IPV is also a significant contributor to the HIV epidemic among women globally and in South

Africa, where young women with violent or controlling male partners are 1.5 times as likely to acquire HIV. Biomedical HIV prevention options that do not require participation from both partners, such as antiretroviral pre-exposure prophylaxis (PrEP), are critical. Further, providing options for approved long-acting PrEP (LA-

PrEP) modalities, including the dapivirine ring and long‐acting injectable cabotegravir (CAB-LA), for AGYW who perceive barriers to daily oral PrEP use, may provide IPV-exposed AGYW in South Africa with greater agency over their sexual health. Pathways for entry to PrEP care from existing public health touchpoints that

engage with AGYW who report experiencing IPV (e.g., rape crisis centers, centers for women and children) are not currently available. However, integrating discussions surrounding HIV prevention into existing IPV care can ultimately serve a population experiencing intersectional stigma to address both IPV and HIV risk. The current

project proposes to conduct formative work to develop a multi-component implementation strategy to link South African AGYW who experience IPV with PrEP options, including LA-PrEP. Guided by the Exploration, Preparation, Implementation, Sustainment framework and the Health Belief Model, this study aims to conduct

qualitative in-depth interviews and a brief cross-sectional survey among IPV-exposed AGYW (AIM 1) and key informants (AIM 2), including potential program implementers and policymakers, to investigate 1) knowledge and opinions of PrEP; 2) preferences for approved PrEP modalities (e.g., oral PrEP, the dapivirine ring, and

CAB-LA); 3) perceived barriers/facilitators to PrEP uptake and adherence among IPV-exposed AGYW; and 4) inner and outer setting factors influencing PrEP delivery. Participants will be asked about barriers/facilitators to PrEP uptake, adherence, and delivery relative to evidence-based PrEP-linkage strategies (e.g., providing

education and/or training, placing a peer navigator at touchpoints, care integration), and suggestions for novel strategies will also be explored. Additionally, we will probe participants to discuss the role that stigma may play in PrEP implementation to inform potential resilience resources that can be incorporated into the strategy. This

formative work will be used in AIM 3 to develop a multi-component PrEP-linkage implementation strategy through iterative consultation with established community advisory board members, including AGYW, local community members, advocates, service providers, and other key stakeholders (AIM 3), that will be tested in a

future pilot trial. In summary, this research aims to respond to AGYW in a generalized HIV epidemic setting who are experiencing IPV by optimizing the implementation of approved PrEP modalities. Findings will ultimately contribute to knowledge on biomedical HIV prevention implementation among priority populations.