Partner HIV Status Knowledge and PrEP Uptake Among Adolescent Girls and Young Women in Oshana Region, Namibia: Associations with Communication and Contextual Factors

Abstract Background Adolescent girls and young women (AGYW) in Sub-Saharan Africa remain disproportionately affected by HIV despite major advances in prevention programming. Oral pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention intervention; however, uptake among AGYW remains heterogeneous and influenced by behavioural, relational, and structural factors. Partner HIV status awareness and communication dynamics may shape prevention engagement, yet evidence from routine implementation settings remains limited. Objective To examine the association between partner HIV status knowledge and current PrEP use among AGYW enrolled in DREAMS-supported HIV prevention programming in Oshana Region, Namibia, and to assess whether communication-related factors were independently associated with PrEP uptake. Methods A cross-sectional, analytical study was conducted using survey data from 311 AGYW aged 15–24 years accessing DREAMS-supported HIV prevention services in Oshana Region, Namibia. Current PrEP use was operationalized as a binary outcome (current use vs non-current use). Descriptive analyses retained all partner HIV status categories. Regression analyses were restricted to respondents reporting HIV-negative or unknown partner HIV status, excluding those reporting HIV-positive partners (n = 5) and those without current sexual partners (n = 51). Age was collapsed into 15–17 years versus 18–24 years to improve model stability. Two multivariable logistic regression models were estimated: a baseline adjusted model and a communication-adjusted model incorporating a communication composite. Adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p-values were reported. Results Among 311 respondents, 127 (40.8%) reported current PrEP use. Compared with AGYW who reported HIV-negative partners, those with unknown partner status had lower odds of current PrEP use (aOR ≈ 0.52, 95% CI 0.30–0.91, p = 0.022). Higher communication comfort was independently associated with current PrEP use (OR ≈ 1.64, 95% CI 1.21–2.26, p = 0.002), and AGYW aged 18–24 years had higher odds of PrEP use than those aged 15–17 years (OR ≈ 7.3, 95% CI 2.40–32.03, p = 0.002). Distance to clinic was also positively associated with current PrEP use (OR ≈ 2.5, 95% CI 1.27–5.26, p = 0.010), whereas economic vulnerability and residence were not independently associated with uptake in adjusted models. A substantial proportion of AGYW with unknown partner status nonetheless reported current PrEP use despite lower communication scores; given the cross-sectional design, this pattern is descriptive and does not establish that PrEP use occurs independently of partner engagement. The three-item communication index showed low internal consistency (Cronbach's α = 0.444) and was treated as a composite indicator rather than a validated scale. Conclusion Current PrEP uptake among AGYW in this implementation setting was significantly associated with partner HIV status knowledge, communication-related factors, and age. AGYW who did not know their partner's HIV status were less likely to report current PrEP use, while stronger communication-related scores were positively associated with uptake. HIV prevention programmes should strengthen differentiated, youth-responsive interventions that address relational barriers, support communication confidence, and improve equitable access to PrEP for younger AGYW.