Barriers and facilitators to oral pre-exposure prophylaxis uptake among adolescents girls and young women at elevated risk of HIV acquisition in Lilongwe, Malawi: A qualitative study

Among the estimated 12,500 new HIV infections in Malawi among people aged 15-24 each year, 70 percent occur in Adolescent Girls and Young Women (AGYW). The Ministry of Health (MoH) in Malawi rolled out an oral Pre-Exposure Prophylaxis (PrEP) prevention program targeting populations at elevated risk of HIV acquisition, including AGYW, in 2021. Since PrEP roll-out, there has been limited research exploring the factors that influence uptake of PrEP among AGYW. This study explored the barriers and facilitators to the uptake of PrEP among AGYW at elevated risk of HIV acquisition. it was an exploratory qualitative study conducted at Kawale Health Center in Lilongwe, Malawi, in February 2023, which employed a phenomenological design. Data were collected using semi-structured in-depth interviews and vignettes from purposively sampled 20 AGYW and 10 health care workers (HCWs) based on their PrEP status (on PrEP versus not on PrEP) and involvement in PrEP provision, respectively. The data were digitally recorded, managed using NVivo software and analysed using a thematic approach guided by the Consolidated Framework for Implementation Research (CFIR). AGYW identified perceived HIV risk and vulnerability and PrEP knowledge as facilitators. HCWs identified AGYW perceived HIV risk, HCW altitudes, and availability of youth friendly service center and resources as facilitators to PrEP uptake. Barriers identified by AGYW included PrEP side effects, limited PrEP information, lack of privacy, stigma, and lack of transportation. HCWs identified limited resources and burden of work as barriers. In conclusion, PrEP's full potential as an HIV prevention tool for AGYW requires a holistic approach that considers their particular requirements, removes systemic hurdles, and guarantees access to high-quality services. In addition, there is a need to create demand to increase the uptake of PrEP.