Pre-exposure Prophylaxis Eligibility and HIV Testing Uptake among Adolescents and Young Adults: Longitudinal Data from Nigeria

In Nigeria, adolescents and young adults (AYA) who engage in multiple sexual partnerships, transactional sex, or needle-sharing are eligible for pre-exposure prophylaxis (PrEP) and are a priority for HIV testing. Using data from the Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) trial, we fit generalized estimating equations to estimate the effects of these PrEP-eligible behaviors on facility-based HIV testing (Aim 1) and HIV self-testing (HIVST) (Aim 2) among AYA aged 14 – 24 years. We used a two-stage weighted approach to generalize estimates from I-TEST to a larger population of all AYA in Nigeria (Aim 3). Of 1,429 trial participants, the median age was 20 years (interquartile range: 18 – 22), 50.3% were female, and 69.4% reported secondary as their highest level of education completed. Recent uptake (i.e. in the last three months) of facility-based HIV testing and HIVST was higher among AYA with one sexual partner, two sexual partners, and three or more sexual partners in the past three months, compared to AYA with no recent sexual partners. AYA who engaged in transactional sex had a higher uptake of facility-based HIV testing and HIVST compared to AYA who never engaged in transactional sex. AYA who shared needles had a lower uptake of facility-based HIV testing and a higher uptake of HIVST compared to AYA with no needle-sharing history. In the generalized AYA population, multiple sexual partnerships was associated with increased uptake of facility-based HIV testing and HIVST (except for AYA with two recent sexual partners who had a lower uptake of HIVST). AYA with a history of transactional sex had a higher uptake of facility-based HIV testing and HIVST compared to AYA who never engaged in transactional sex. AYA who shared needles had a lower uptake of facility-based HIV testing and a higher uptake of HIVST compared to AYA who never shared needles. While facility-based HIV testing approaches may reach AYA engaged in multiple sexual partnerships or transactional sex, greater attention is needed to reach AYA who share needles. AYA with these PrEP-eligible behaviors are also likely to use HIVST as an entry point into HIV prevention services.