Browsing by Author "Rousseau, Elzette"

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    A community-based mobile clinic model delivering PrEP for HIV prevention to adolescent girls and young women in Cape Town, South Africa
    (2021-08-28) Rousseau, Elzette; Bekker, Linda-Gail; Julies, Robin F.; Celum, Connie; Morton, Jennifer; Johnson, Rachel; Baeten, Jared M.; O’Malley, Gabrielle
    Background Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities. Methods We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16–25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context. Results A total of 585 young women started PrEP at the TTT between July 2017 – October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT’s integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery. Conclusions PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs.
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    Gendered lives, constrained choice and young African women's PrEP uptake and persistent use as a gender-responsive approach to HIV prevention
    (2024) Rousseau, Elzette; Bekker, Linda-Gail; Sikkema, Kathleen
    While there is substantial momentum to scale up PrEP (pre-exposure prophylaxis) for HIV prevention in adolescent girls and young women (AGYW), this population is demonstrating difficulty in sustained PrEP use. PrEP use at the time of HIV exposure is critical for effectiveness. This thesis investigated AGYW's decision-making throughout the PrEP-user journey (from PrEP uptake to persistence or discontinuation). It reflected on the role of agency (personal and relational), gender, and PrEP access and how these facilitated or constrained PrEP use. The research used a multi-method approach, including pharmacy record review, in-depth interviews, and structured surveys. This cohort included 2550 AGYW participants (aged 16-25 years) of the POWER implementation study receiving oral PrEP for up to 36 months in Cape Town and Johannesburg, South Africa, and Kisumu, Kenya. The POWER study was designed to develop and evaluate scalable models of PrEP delivery. Across analyses, PrEP uptake facilitators included PrEP integration with sexual and reproductive health services but were hampered by PrEP misconceptions and stigma in the community. Disclosure, social support, adolescent-friendly counselling, and convenient access were key enablers for PrEP persistence. Beyond this, AGYW were influenced by intrinsic (strong self-determination and autonomy finding PrEP adherence personally fulfilling) and extrinsic motivations (where PrEP use habits are influenced by external factors or rewards, social pressure, or fear of negative relational consequences). The research showed that AGYW's diversity in needs, habits, and lifestyles also influenced their PrEP access preferences, which led to the segmentation of this group into convenient, independent, social, or discreet PrEP users for optimised tailored service delivery. While the role of sexual relationship power in AGYW's PrEP continuation was also investigated, no significant influence was observed. In conclusion, the findings suggest that AGYW are empowered to make positive PrEP use decisions when their agency is ignited and/or when AGYW are presented with access alternatives to choose from (differentiated models of PrEP delivery). AGYW's agency fluctuated in contexts of community stigma, non-disclosure, harmful relationship dynamics, and emotional arousal; however, differentiated PrEP access created alternatives (a potential buffer zone) for these instances of limited agency.
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    Oral PrEP use among pregnant or parenting young women in South Africa: evidence from a large community-based implementation study
    (2026) Chen-Charles, Jenny Davey, Dvora J. Rousseau, Elzette Little, Francesca Toska, Elona Mathola, Ntombovuyo Macdonald, Pippa Vanto, Onesimo Wallace, Melissa Bekker, Linda-Gail; Davey, Dvora J; Rousseau, Elzette; Little, Francesca; Toska, Elona; Mathola, Ntombovuyo; Macdonald, Pippa; Vanto, Onesimo; Wallace, Melissa; Bekker, Linda-Gail, Melissa
    Abstract Background The risk of HIV acquisition is heightened during pregnancy and early parenthood with the additional risk of vertical HIV transmission. While recent studies have improved our understanding of PrEP use among pregnant and breastfeeding women, further evidence is needed to inform the design of interventions that support sustained use, especially among young women who are pregnant or parenting. Methods We analysed data from young women aged 15–29 years who initiated PrEP in an implementation study (FastPrEP) in Cape Town, South Africa. Logistic regression was used to examine the association between pregnancy or parenting status (≥ 1 living child) and PrEP discontinuation at 1- and 4-months post-initiation, based on pharmacy refill data. The primary exposure was currently pregnant or having a child (vs. not); secondary analyses stratified by age (15–24 vs. 25–29 years) among women who were pregnant/parenting. Models were adjusted for age and hypothesised explanatory factors were included in sensitivity analysis: service delivery location, contraceptive use, HIV risk perception, and relationship status. Results Between August 2022 and June 2024 n = 4,876 young women initiated PrEP; 44% were pregnant/parenting (of which 10% were pregnant), and the median age was 21.6 years (IQR:18–25). At 1-month, women who were pregnant/parenting had higher odds of PrEP discontinuation (aOR:1.30, 95% CI:1.14–1.49). At 4-months this relationship persisted (aOR:1.41, 95% CI:1.12–1.78) compared with non-pregnant/parenting women. Among those pregnant/parenting, younger women (15–24 years) had higher odds of discontinuation at 1-month (aOR:1.31, 95% CI:1.08–1.58) and 4-months (aOR:1.41, 95%CI:1.02–1.96) compared to women aged 25–29. In the fully adjusted multivariable model, receiving PrEP in mobile clinics (aOR:0.71, 95% CI:0.61–0.82) vs. government clinics was associated with lower odds of early discontinuation. Conclusion Young women who are pregnant/parenting face elevated risk of early PrEP discontinuation. Differentiated, life-stage and youth-responsive interventions, such as counselling, partner involvement, and integration with maternal and child health, or sexual and reproductive health services, are critical to improving PrEP persistence among this priority population. This population should be prioritised in the rollout of long-acting PrEP formulations, which may better align with their needs and reduce the burden of daily adherence.